POLST (Physician Orders for Life-Sustaining Treatment) — also called POST, MOLST, MOST, or similar names depending on the state — is a set of actionable medical orders designed for patients with serious illness, advanced frailty, or limited life expectancy. Unlike an advance directive, which expresses future preferences, a POLST translates current goals of care into orders that travel with the patient across care settings.
The form is the output. The goals-of-care conversation is the clinical work.
CLINICAL PRINTABLE
Coming Soon.
A clinical reference for this topic is in development.
1 · What Is a POLST?
- POLST is a medical order — it is immediately actionable by EMS, nursing staff, and other clinicians without a separate physician order in most states.
- It is designed for patients who have a serious illness, advanced frailty, or a prognosis measured in months to years — not for healthy adults planning ahead.
- POLST typically addresses resuscitation preferences, level of medical intervention (comfort-focused, limited, or full), and artificial nutrition — though the specific sections vary by state form.
- It is completed through a conversation between the clinician and the patient or surrogate, and signed by the clinician (and in some states, the patient or surrogate as well).
2 · POLST vs Advance Directive vs HCPOA
POLST vs Advance Directive
An advance directive expresses future preferences — what a person would want if they could not speak for themselves. A POLST translates current goals into current medical orders. Both can coexist; they serve different functions.
POLST vs Code Status Documentation
A code status order in the hospital chart is specific to that setting. A POLST is designed to be portable — it travels with the patient across care settings including home, SNF, and EMS response.
POLST vs Healthcare Power of Attorney
A healthcare POA designates a decision-maker. A POLST documents the decisions that have already been made through a goals-of-care conversation. Both are part of a complete advance care planning picture.
3 · Appropriate Patient Population
- Patients with advanced cancer, heart failure, COPD, dementia, or other serious illness with a prognosis measured in months to years.
- Patients with advanced frailty or significant functional decline who would not benefit from aggressive resuscitation.
- Patients who have expressed clear preferences about life-sustaining treatment that should be documented as orders.
- Patients transitioning between care settings where consistent orders are clinically important.
4 · When to Review the POLST
- After hospitalization or a significant acute illness.
- After a significant change in clinical status, prognosis, or functional trajectory.
- When the patient expresses a change in goals or preferences.
- At care transitions — discharge to SNF, home hospice enrollment, or return to the community.
5 · State-Specific Variation
- The form name varies by state: POLST, POST, MOLST, MOST, TPOPP, and others.
- Required signatures vary — some states require only the clinician; others require the patient or surrogate as well.
- Portability across state lines is not guaranteed — a POLST completed in one state may not be legally recognized in another.
- Know your state's specific form, signature requirements, and EMS recognition rules.
Bottom Line
POLST is a medical order — it is immediately actionable by EMS, nursing staff, and other clinicians without a separate physician order.
EVIDENCE & REFERENCES
- National POLST. POLST Form & Programs. National POLST Paradigm. 2023. https://polst.org
- Hickman SE, et al. The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation. J Law Med Ethics. 2008;36(1):119-140. doi:10.1111/j.1748-720X.2008.00242.x
- Fromme EK, et al. Association between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and In-Hospital Death in Oregon. J Am Geriatr Soc. 2014;62(7):1246-1251. doi:10.1111/jgs.12889