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Planning AheadPractical Management

Clarity is Kindness

A practical guide to POLST—what it is, how it works, and why having clear documentation brings confidence when decisions must be made under pressure.

We reflected on how the lack of clarity can shake even the most well-communicated plans, leading to doubt and second-guessing. Having documentation—like a POLST (Physician Orders for Life-Sustaining Treatment)—can be a powerful way to bring shared understanding and confidence to everyone involved, especially when decisions need to be made under pressure.

Understanding POLST

What is a POLST? POLST stands for Physician Orders for Life-Sustaining Treatment. It’s a medical order that communicates a person’s wishes about specific treatments at the end of life. It’s designed for people who are seriously ill or frail, those for whom health care providers wouldn’t be surprised if they died within a year.

Unlike advance directives, which are broader and often prepared years in advance, a POLST form provides clear, actionable medical orders that health professionals follow immediately in a crisis.

What a POLST is Not

  • It is not an advance directive (though they work together)
  • It is not a living will
  • It is not a replacement for conversations about values and goals
  • It is not meant for healthy individuals or those with a long life expectancy

What a POLST Is Used For

  • Directing emergency medical personnel about what to do during a crisis (e.g. whether to perform CPR or use a ventilator)
  • Clarifying treatment preferences such as Do Not Resuscitate (DNR) or limits on hospital transfers, intubation, or feeding tubes
  • Ensuring that medical care aligns with the patient’s values and goals in a way that is honored across settings—home, hospital, long-term care, hospice

How to Create a POLST

  1. Have the conversation.

    • Talk with your loved one about their wishes, values, and what matters most to them
    • Use tools like The Conversation Project or Five Wishes to guide discussions

  2. Talk to the health care provider.

    • A POLST must be completed and signed by a physician (MD/DO), nurse practitioner, or physician assistant
    • Ask their provider directly if they can help initiate the form

  3. Document and distribute.

    • Once completed, make sure copies are kept:
      • In the home (posted visibly on the refrigerator)
      • In medical records
      • With family members and caregivers
      • In glove compartments for transport emergencies
      • Some states allow electronic registration

State-by-State POLST Programs

POLST programs vary by state in name and format. Some common names include MOLST (Medical Orders for Life-Sustaining Treatment) or MOST (Medical Orders for Scope of Treatment).

Additional Resources