History of the POLST Paradigm Initiative

The POLST Paradigm Initiative began in Oregon in 1991. Medical ethics leaders recognized that patient wishes for life-sustaining treatments were not being honored consistently despite the availability of advance directives. The Center for Ethics in Health Care at Oregon Health & Science University convened representatives from stakeholder health care organizations to develop the Medical Treatment Coversheet; portable medical orders based on a patient's values for life-sustaining treatments.

After initial evaluation and a name change to "Physician Orders for Life-Sustaining Treatment" (POLST) the form was released for use in Oregon in 1995. Using a "train-the-trainer" model, members of the task force initially educated health care professionals about use of the form. Ongoing education, research and a statewide experience-based continuous quality improvement process helped the task force improve the content of the POLST form and the process of implementation.

As Oregon's program evolved, selected regulations rather than legislation were used to help with implementation. Other developing programs like West Virginia and New York sought legislation to facilitate POLST paradigm adoption. Each new program found that their approach needed to be thoughtfully tailored to state laws and regulations. An investigation by task force members, published in March 2008, underscores the need to understand state policies and rules in helping choose the best path for implementation (See Article).

With over one million forms distributed, the use of POLST in Oregon is now the accepted medical standard of care. The form is used by all hospices and over 95% of nursing homes in the state. Other states (New York, Pennsylvania, Washington, West Virginia, and Wisconsin) were early to develop programs similar to Oregon's POLST program and have extensive experience and resources available (See Resources). In 2004, leaders of these programs became the original members of the National POLST Paradigm Initiative Task Force. The task force aims to facilitate the development of other programs, help develop policy and conduct research. A growing number of other states and communities are benefiting from task force efforts by implementing their own POLST Paradigm Program as shown on the frequently updated U.S. map. The task force coined the term "POLST Paradigm" to describe these programs.

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