Getting the Most from POLST

Author: Jeffrey Gudin

Many clinicians still haven't heard about the concept of Physician Orders for Life-Sustaining Treatment or POLST. Some states call it POST or MOST. But they all basically mean the same thing. What we're trying to do is get patients to play an active role in the decision-making about their future care. Unfortunately, many patients suffer at the end of life - intensive care unit, unnecessary treatments, mechanical ventilation, feeding tubes, things that people might not want if given the option. Studies have shown that simply by making your wishes known, it really changes the outcome in the world of healthcare. It obeys patient's wishes and it's better for everyone involved.

One of the most common questions is, what is the difference between a POLST form and an advanced directive? One of the difference is, an advanced directive is something we could do when we're young and healthy. This could be a 15- or 20-page legal document, one that healthcare providers might not have the time to read in a case of an emergency. A POLST is really meant to accompany the advanced directive. Hopefully, they both say complementary messages. But you can look at the POLST form and in a matter of seconds tell whether the patient wants resuscitative measures, feeding, artificial ventilation - these kind of things. Here is what I've been doing in my own office: I keep a stack of POLST forms, and I open the conversation with my patients. I say "Here, I want you to take this home. You don't have to complete it. But all we want as clinicians is to obey your wishes." And it forces patients to start to think about what they want for their future if the time were to arise. So I think, really as time moves forward and as we realize that many patients are suffering at the end-of-life when they don't have to, it would be nice to get patients involved in the decision-making of their own care now. Because maybe in the future, they might not be able to participate.

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