Physician Orders for Life Sustaining Treatment (POLST)
What's the right level of care at the end of life? Even for the very ill the answer is not always "more" or repeated and painful heroic attempts. The pink POLST form helps medical staff respect patients' wishes in their final days. All too often families fail to have conversations about the intensity and type of medical interventions patients want at the end of life. In part this is because death is not easily accepted; it's also due to a health care system that seldom asks patients what they want. Yet without these conversations, and a way to document them, patients can end up on a runaway medical train, undergoing painful, ineffective, unwanted 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 supports the use of Physician Orders for Life-Sustaining Treatment (POLST). POLST is a standardized medical order form that indicates whether a seriously ill patients does or does not want the specific types of life-sustaining treatments. Unlike a Health Care Directive, both the patient and her/his physician signs the California POLST and it becomes a set of medical orders. POLST form travels with the patient as part of her/his medical record and must be honored across all care settings. When used with an Advance Directive(which names a proxy decision maker) POLST reduces unwanted or medically ineffective care, reduces patient and family suffering, and ensures that patients' end of life wishes are honored.
Currently 32 states 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 statewide awareness through a comprehensive communications strategy and a stakeholder taskforce
- Creating a standardized approach to implementation with hands-on education and uniform materials
- Stimulating adoption through the efforts of localized POLST coalitions
- Examining our effectiveness through an evaluation underway by the University of California, Los Angeles
Leadership and oversight of these activities is provided by the Coalition for Compassionate Care of California, with support from consultants and others. The Coalition supports local groups to promote adoption of POLST by hospitals, skilled nursing facilities, emergency medical services, and home health care agencies.
Over the past four years CHCF funded these coalitions (*funding through 2012):
- Alameda-Contra Costa Medical Association, Alameda & Contra Costa Counties*
- Anderson Valley Health Center, Mendocino County
- Brentwood Biomedical Research Institute, West Los Angeles
- Central California Valley Coalition, Fresno, Kings, Madera, Mariposa, Merced, & Tulare Counties
- Community Network for Appropriate Technologies, Sonoma County
- Compassionate Care Alliance, Monterey County
- Eskaton, Sacramento County
- Greater Bakersfield Better Care Coalition, Kern County
- Hospice of Santa Cruz, Santa Cruz County
- Humboldt-Del Norte IPA, Del Norte & Humboldt Counties
- Huntington Memorial Hospital, Pasadena
- Inland Empire Palliative Care Coalition, San Bernardino County*
- Monarch Healthcare, Orange County*
- Queen of the Valley Medical Center, Napa County
- Riverside County Physicians Memorial Foundation, Riverside & San Bernardino Counties
- San Diego County Medical Society, San Diego County*
- San Francisco Medical Society (with the Metta Foundation)*
- Stanislaus POLST Coalition
- Valley Care Community Consortium, San Fernando Valley
- Ventura County Medical Association, Ventura County*
- VMC Foundation & Santa Clara County Medical Center, Santa Clara County*
- Woodland Healthcare Foundation, Yolo County
For more information on POLST see the links below.