The National POLST Paradigm is an approach to advance care planning developed for patients with one or more serious illnesses or frailty. The POLST Paradigm is based on a conversation between you and your health care professional. The POLST conversation is about: (a) your specific disease, treatment options (including benefits and alternatives), and what will happen as the patient’s disease continues; and (b) your goals of care and values. After the conversation, your health care professional will fill out a POLST form, marking what treatments you do or do not want at the end of your life. Since the POLST is a medical order, once your health care professional signs it, it means that your treatment wishes will be known and should be followed during a medical emergency, regardless of where you are.
Advance care planning is different for each person. Everyone must think about their values and what is important for them at the end of their life. POLST is not for everyone; POLST is only for those individuals diagnosed with serious illness or frailty, for whom a health care professional would not be surprised if they died within one year. This section of the website will help you determine if POLST is something that would be helpful for you or for a loved one.
The National POLST Paradigm Task Force invites you to review our Frequently Asked Questions to understand POLST in more detail, learn about the differences between POLST and advance directives, and listen to stories about others’ experiences with POLST.
What are some of the medical terms used when talking about serious illness?
Advance Directives are written instructions stating how you wish your medical decisions to be made if you become unable to make decisions for yourself. Sometimes Advance Directives are called living wills. Most states allow patients to appoint a person to make health care decisions on their behalf when patients cannot speak for themselves.
Antibiotics treat some infections (such as pneumonia) that can develop when a person is seriously ill. Antibiotics may also treat symptoms (such as with a bladder infection).
When a person can no longer eat or drink by mouth, liquid food can be given to them by tube.
Cardiopulmonary resuscitation (CPR)
CPR attempts to restart breathing and/or the heartbeat of a person who has no heartbeat and/or has stopped breathing. It typically involves “mouth-to-mouth” and forceful pressure on the chest to restart the heart. This procedure may also involve electric shock (defibrillation) or a plastic tube down the throat into the windpipe to assist breathing (intubation).
Comfort measures describes care that is undertaken with the primary goal of keeping a person comfortable (rather than prolonging life). On the POLST 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
IV fluids are administered directly into the vein via a small plastic tube (catheter). Typically, they are given on a short-term basis.
When a person is no longer able to breathe on his/her own, a plastic tube is put down the throat and a machine pumps air in and out of the lungs through the tube.
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).
If you are unable to make decisions for yourself, most state laws allow a family member or designated surrogate to serve as your representative and make decisions for you. If you have completed a medical power of attorney or health care proxy, the person designated on that form will be your legal health care representative.