POLST is the bright pink form that tells family members, caregivers, and providers what types and levels of care a person wants in the final phase of life. POLST is a powerful tool — but as with all tools, POLST loses its power if it is not available when it’s needed.

Today we have no reliable way to ensure that the wishes expressed in the POLST are known at the time treatment decisions are being made. We could make the information available to everyone who needs it by establishing a statewide registry that would enable care providers to access a patient’s wishes as the care is being planned and provided.

POLST — Physician Orders for Life-Sustaining Treatment — allows people to articulate their wishes and assert more control over their end-of-life care. POLST is a medical order that is recognized throughout the health care system, and it’s more powerful than its more familiar cousin, the advance directive. Everyone over age 18 should complete an advance directive that provides guidance for future treatment and appoints a health care representative. But POLST is designed for people who have a chronic progressive illness, a serious health condition, or are medically frail. POLST provides medical orders for current treatment signed by a physician and the patient. It guides the intensity of treatment options initiated by emergency responders, emergency room personnel, intensive care unit staff, and other providers. The timeliness and specificity of the POLST form make it a powerful tool for ensuring a patient’s wishes are known and respected.

Immediate access to end-of-life treatment information is especially important during medical emergencies. However emergency responders often have no access to hard copies of POLST forms. While the POLST form is meant to travel with the patient between care settings, the form can get lost during transfers — or never sent with the patient at all.

If a statewide registry were established, it would make POLST information available to any qualified provider, anywhere, at any time. It would provide a reliable verification system if the paper POLST form or electronic health record were unavailable. With round-the-clock phone and electronic access to POLST information, providers would be able to follow a patient’s wishes even at the most stressful moments. The five-year-old Oregon POLST registry provides an example of a successful statewide effort.

California already has much of the necessary infrastructure to develop a POLST registry:

• The POLST form is well accepted by providers and patients.
• Coalitions across the state are working to expand POLST dissemination and adoption.
• California’s POLST program has long operated under a successful public/private partnership.

Policymakers are interested in solving the problem of POLST forms not being available when they are needed most. On the first day of this legislative session, Senator Lois Wolk introduced SB 19, the California POLST Registry Act.

The POLST form — when complete and accessible — can help ensure our preferences are honored in the final chapter of our lives. Patients, families, and providers will be better off if we establish the infrastructure to enable health care providers to easily access our POLST forms and honor our preferences.

End-of-life conversations are some of the most meaningful interactions with our loved ones. Let’s be sure Californians’ care preferences are documented, available when needed, and taken into account.

Watch a recent CHCF briefing about the need for a POLST registry.

Sandra Shewry

Sandra Shewry served on staff at CHCF from 2012 to 2022. She was vice president for CHCF’s External Engagement team and also served as CHCF’s director of State Health Policy. Prior to joining the foundation, she was president and CEO of the Center for Connected Health Policy, a nonprofit organization working to remove policy barriers to the integration of telehealth technologies into California’s health care system. Sandra held a number of senior leadership positions within California state government, including director of the California Department of Health Care Services, which administers the state Medicaid program (Medi-Cal). Other programs under her leadership included public health, emergency preparedness, and licensing of health facilities. She also served as the executive director of the California Managed Risk Medical Insurance Board. Sandra received bachelor’s degrees in community studies and psychology from the University of California, Santa Cruz, and master’s degrees in public health and social welfare from the University of California, Berkeley.

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