FAQ

+ What is the POLST form?

The POLST form is a physician order set that helps guide care for a patient as their illness progresses. It is the end result of a meaningful conversation between a patient and their doctor and/or trained facilitator. This conversation should include a discussion of illness severity, prognosis, treatment options and most important, the patient’s values and goals of care. When conducted appropriately it will inform decisions regarding the care the patient wants and the care they do not want to receive. As a result, a POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering and optimize the likelihood that the patient’s wishes will be honored.

+ What information is included on the POLST form?

The main focus of the conversation and the form are to plan for the level of care and treatment the patient wants. These fall into three categories: full, selective and comfort care interventions. Documentation includes instructions regarding

• cardiopulmonary resuscitation,
• intubation and mechanical ventilation, and
• artificial nutrition.

+ What does “MOST” stand for?

MOST stands for Medical Orders for Scope of Treatment. It was the Texas version of “POLST” (Physician Orders for Life-Sustaining Treatment), a national initiative to improve advance care planning processes. Since these processes are regulated by the state, each state must adopt its own form to be compliant with state law. In Texas, “MOST” matched to the language of the Texas Advance Directives Act and was selected by early implementers. Each state that has adopted this conversational paradigm and documentation method has named it to correspond with their state’s statutes. The key is that this is a portable order set resulting from a shared decision making conversation between a patient dealing with serious and progressive life-threatening illness and their health care provider. Texas is following the best practices of many other states and moving to have our form match those and from here forward calling our process and form Texas POLST.

+ Why was POLST developed?

POLST was developed because patients were often receiving care and treatment interventions that were inconsistent with their wishes. The goal of MOST is to provide a framework for healthcare professionals that guides their decision-making so that patients receive the treatments they DO want and avoid the treatments they DO NOT want.

+ Is POLST mandated by law?

The conversation and its resulting form are entirely voluntary. We want patients to have the best opportunity to participate in their care. A well done shared decision-making conversation facilitates reflection about life experience, what matters most in the time remaining and collaboration with their health care professionals to make the best decisions possible about how to use that time.

Medical order sets have existed for a long time in health care delivery. POLST is an order set that follows that tradition. It complements other advance care plans such as the Medical Power of Attorney and the Living Will, sometimes called the Directive to Physicians, Families and Surrogates.

Some states have found it preferable to establish their POLST Program through clinical consensus rather than legal mandate . In those states, since it is a clinical program implemented by means of medical orders, health care professionals view it like other medical orders, for which there is normally no need for authorizing legislation. Since rationality tends to disappear whenever Texas considers end of life legislation, we continue to focus on growing adoption through clinical consensus.

+ Does POLST replace advance directives?

POLST complements advance directives and is not intended to replace those documents. An advance directive is still needed to appoint a legal health care decision-maker. POLST is an order set that goes into effect upon completion and signature whereas advance directives go into effect when patients are unable to speak for themselves. While different, these documents complement each other and their contents regarding care decisions should be internally consistent. A meaningful, high quality shared decision-making conversation is fundamental to completing these documents.

+ If a patient has an advance directive and a POLST form, which takes precedence?

The advance directives prevail which is why making them consistent matters.

+ Who should have POLST?

POLST is designed for patients with serious and progressive life-limiting illness. It is appropriate for patients for whom their physician would not be surprised if they were to die in the next 12-18 months. Also, patients with advancing frailty due to age are appropriate for this conversation.

+ Who should discuss and complete the POLST form with patients?

High quality shared decision-making conversations about treatment goals and preferences between patients, health care providers and loved ones is critical to this process. The physician is often the one who identifies that the patient is at an appropriate point in the trajectory of their illness to recommend that this conversation happens and is documented. Other trained staff members such as nurses, social workers or chaplains may also play a role in facilitating the conversation. However, physicians are responsible for signing (certifying) the POLST form.

+ How can I obtain copies of the POLST form to use?

The form may be found on the Texas Talks website in the “Resources” tab under the “Forms” section.

+ What should be done with the POLST form after it is completed?

The original form typically stays with the patient at all times. If a patient is transferred, the form should go with them: In the hospital or other care facility setting, the form should be kept in the patient’s medical record.
At home, the form may be placed on a table near the patient’s bed or on the refrigerator so emergency medical personnel can find it easily if they are called.

We also recommend that patients consider an electronic storage service that is available through apps and other online services. Finally, it is critical that patient’s share a copy of the POLST document with the person they have selected to make decisions for them.

+ Can a patient’s POLST form be changed?

Yes. The form can be modified or revoked by a patient, verbally or in writing at any time. The patient’s decision maker, acting on the patient’s behalf if the patient no longer has competency, may also initiate changes.

+ When should a patient’s POLST form be reviewed?

A patient’s POLST form should be reviewed:

• When the patient is transferred from one medical or residential setting to another;
• If there is a significant change in the patient’s condition;
• If the patient’s treatment preferences change, and
• On an annual basis.

+ Are faxed copies or photocopies valid?

Yes.

+ Is the POLST form available in other languages?

A Spanish translation is available as a tool to be used when explaining POLST to patients for whom Spanish is their first language. However, since POLST is a medical order set the English version must be completed and signed so that personnel can follow the orders.