Frequently Asked Questions

States and communities have developed programs similar to Oregon's POLST program, and may have a different name. The term "POLST Paradigm" is used to describe these programs.

What is the POLST Paradigm form?

The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm form is a brightly colored, medical order form. Your health care professional may use the POLST Paradigm form to write orders that indicate what types of life-sustaining treatment you do or do not want if you become seriously ill.

Who should have a POLST Paradigm form?

If you have a serious health condition you need to make advance decisions about life sustaining treatment. Your physician or nurse practitioner can use the POLST form to represent your wishes as clear, specific written medical orders.

For which persons should POLST be used?

Use of the POLST form is most appropriate for seriously ill persons with life-limiting, also called terminal, illnesses. To determine whether a POLST form should be encouraged, clinicians should ask themselves, "Would I be surprised if this person died in the next year?" If the answer is "No, I would not be surprised", then a POLST form is appropriate. Remember that a POLST form is designed to express the individual’s preferences for levels of treatment and can indicate either full treatment including resuscitation attempts or can be used to limit those interventions that are not desired by the individual. Unless it is the patient’s preference, use of the POLST form to limit treatment is not appropriate for persons with stable medical or functionally disabling problems who have many years of life expectancy. In the absence of a POLST form or other state-specific do-not-resuscitate orders, patients will receive advanced cardiac life support, including CPR, endotracheal intubation, and defibrillation, by emergency medical personnel based on standard protocols.

Does law require it?

The POLST Paradigm form is voluntary and is intended to:

• Help you and your health care professional discuss and develop plans to reflect your wishes,
• Assist physicians, nurses, health care facilities, and emergency personnel to honor your wishes for life-sustaining treatment.

Who completes and signs the POLST Paradigm form?

A health care professional must sign this form in order for it to be followed by other health care professionals. Other health professionals who work with your health care professional may complete the form.

I have an advance directive, do I need a POLST Paradigm form too?

Even if you have an advance directive, the POLST Paradigm form is recommended.

Additionally, you may obtain more information about advance directives from your health care professional or from www.caringinfo.org

What if my loved one can no longer communicate her/his wishes for care?

Family members may be able to speak on behalf of a loved one. A health care professional can complete the POLST Paradigm form based on family members' understanding of their loved one’s wishes.

Where is the POLST Paradigm form used?

The POLST Paradigm form remains with you if you are moved between care settings, regardless of whether you are in the hospital, at home, or in a long-term care facility. If you live at home, keep the original pink POLST Paradigm form on the refrigerator where emergency responders can find it. If you live at a long-term care facility, POLST Paradigm form will be kept in your chart.

What are some of the medical terms used when talking about serious illness?

• Advance Directives: Advance directives are written instructions stating how you wish your medical decisions be made if you become unable to make decisions for yourself. Some advance directives are sometimes called living wills. Most states allow patients to appoint a person who can make health care decisions on their behalf when patients cannot speak for themselves.
• Antibiotics: Antibiotics treat some infections (such as pneumonia) that can develop when a person is seriously ill.
• Artificial nutrition: When a person can no longer eat or drink by mouth, liquid food can be given to them by tube.
• Cardiopulmonary resuscitation (CPR): Attempts to restart breathing and the heartbeat of a person who has no heartbeat or has stopped breathing. Typically involves “mouth-to-mouth” and forceful pressure on the chest to restart the heart. May also involve electric shock (defibrillation) or a plastic tube down the throat into the windpipe to assist breathing (intubation).
• Comfort measures: Care undertaken with the primary goal of keeping a person comfortable (rather than prolonging life). On the POLST Paradigm form, a person who requests “comfort measures only” would be transferred to the hospital only if needed for his or her comfort.
• Intravenous (IV) fluids: A small plastic tube (catheter) is inserted directly into the vein and fluids are administered through the tube. Typically, IV fluids are given on a short-term basis.
• Mechanical ventilation/respiration: A plastic tube is put down the throat to help breathing. A machine pumps air in and out of the lungs through the tube when a person is no longer able to breathe on his/her own.
• Tube feeding: On a short-term basis, fluids and liquid nutrients can be given through a tube in the nose that goes into the stomach (nasogastric or “NG” tube). For long-term feeding, a tube can be inserted though a surgical procedure directly into the stomach (gastric or “G” tube) or the intestines (jejunal or “J” tube).
• Medical decision maker: If you are unable to make decisions for yourself, most state laws allow a family member to serve as your representative and make decisions for you. If you have completed a medical power of attorney, the person designated on that form will be your legal health care representative.

How can I get more information about the POLST Paradigm program ?

Ask your health care professional or contact: