Physician Orders for Life-Sustaining Treatment (POLST)

What's the right level of care at the end of life? The answer is not always "more" — even for the very ill. The pink POLST form helps medical staff respect patients' wishes in their final days.

February 2013

Without a conversation about a person's preferences for medical interventions, and a way to document them, patients can end up on a runaway medical train, undergoing ineffective, unwanted, painful, and expensive treatments while their psychological, emotional, and spiritual needs are poorly addressed.

To help patients have their say if they are unable to speak, CHCF has supported the use of Physician Orders for Life-Sustaining Treatment (POLST). POLST is a standardized medical order form that indicates the specific types of life-sustaining treatment a seriously ill patient does or does not want.

In the video below, the POLST form is discussed by Sister Martin de Porres Coleman, resident and care coordinator at Mercy Retirement and Care Center in Oakland, California.

What makes POLST powerful is that, unlike a health care directive, it is signed by the patient and physician and becomes a set of medical orders. And unlike a directive, the POLST form moves with the patient as part of the medical record. When used with an advance directive that names a proxy decisionmaker, POLST can reduce unwanted or ineffective care, reduce patient and family suffering, and ensure that patients' wishes are honored.

Currently, 47 states have implemented POLST or are developing similar programs. A California law in effect since 2009 requires that POLST be honored in all care settings and gives immunity to providers who honor a POLST document in good faith.

Since August 2007, CHCF has supported POLST adoption by:

  • Promoting awareness through a communications strategy and a stakeholder taskforce
  • Creating a standardized approach to implementation with hands-on education and uniform materials
  • Stimulating adoption through funding 22 POLST coalitions across California

The Coalition for Compassionate Care of California provides leadership and oversight of these activities. The coalition supports local groups to promote adoption of POLST by hospitals, skilled nursing facilities, emergency medical services, and home health care agencies.

Independent Project Evaluation

CHCF commissioned an evaluation of the community coalition efforts. California nursing homes were randomly selected in coalition and non-coalition areas to be surveyed about POLST usage. The evaluation, Implementation of POLST in Nursing Homes in California: Evaluation of a Novel Statewide Dissemination Mechanism, was published in January 2013.

For more information on POLST, see the External Links below.