POLST is an acronym meaning Physician Orders for Life Sustaining Treatment. Initiated in Oregon in 1991, the POLST Paradigm Initiative aims to improve compliance with end-of-life treatment wishes of individuals, through the creation of local task forces composed of physicians and other health professionals. Local task forces develop and implement a community-based program by educating the public and training local health professionals in the use of the POLST form.

The POLST form is developed and standardized in each region, although it always contains a physician's signature and specific orders about medical interventions, such as tube feedings, CPR, antibiotics, and comfort measures, the patient's desired limits on interventions, and more. The form travels with the patient -- from an assisted living facility to a nursing home, to a hospital, and so on. POLST Paradigm Initiatives currently exist in more thahospitaln 30 states.

The National Institute of Nursing Research (NINR), a part of the National Institutes of Health (NIH) sponsored a study evaluating the program's effectiveness, which concluded earlier this year. The study, published in the July issue of the Journal of the American Geriatrics Society, found that compliance with patients' end-of-life wishes related to medical interventions was significantly greater if a POLST form was used, compared to traditional Do-Not-Resuscitate orders (DNR):

  • Residents who used a POLST form were 59% less likely to receive unwanted life-sustaining treatments than residents who had standard DNR orders.
  • Residents with POLST orders for comfort care only were 67% less likely to receive life-sustaining treatments than those who indicated that they wanted full treatment on their POLST forms.
  • Residents with POLST forms were more likely to have their treatment preferences documented as medical orders.
  • 98% of residents with POLST forms had specific end-of-life wishes related to other medical interventions (beyond resuscitation) compared to 16% of residents without POLST forms.
If your area does not yet have a POLST Paradigm Initiative, you can find information on developing a program on the POLST website.

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