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Physician Orders for Life Sustaining Treatment "POLST" - Problems and
Recommendations


The POLST form has exploded into the consciousness of California health care providers. The meteoric rise of POLST as part of advance health care planning has been the result of a well-organized and coordinated effort to sell the POLST form’s considerable benefits. The greatest benefit is that POLST is meant to inspire a conversation – a conversation between physicians and other health care providers with their patients who are at the end of their lives. However, POLST has caused deep concerns among many health care consumer advocates who publicly wonder if POLST is doing more harm than good for Californians.

This policy analysis is devoted to assessing POLST – from the good to the bad to the ugly. The analysis begins with an overview of the positive features of POLST as an advance care planning tool. The discussion then shifts to the considerable problems that POLST presents, from the form itself to its statutory foundation and subsequent implementation. The analysis concludes with a lengthy list of recommendations for eliminating or reducing some of the POLST problems.

As part of its analysis, CANHR conducted a survey of Long-term Care Ombudsman regarding the POLST in practice. The survey revealed a very disturbing level of misrepresentation and misuse of POLST such that one wonders if the forms are in fact causing more harm than good. The forms certainly have their place as a useful advance health care planning tool. The problem is the good intentions of the POLST form’s proponents have not addressed the troublesome realities of a health care profession that often leaves patients groping for information to elucidate their options. In short, POLST fails to recognize that for many patients, the health care system is simply not interested in a conversation.

The POLST White Paper is available here.