What’s the difference between a POLST form and an advance directive?

By Lyle Solomon

Important terms

Advance directive: An advance directive is a document specifying who will make medical choices on the patient’s behalf if and when they become incapable of doing so. This document is also called a “health care power of attorney.”

POLST form: A Portable Medical Orders form, or POLST, is a list of medical directives that only apply to a specific patient population and deal with a small number of crucial medical choices.

Question: What’s the difference between a POLST form and an advance directive?

Answer: An advance directive is not a replacement for a POLST form, nor are POLST forms an alternative to an advance directive. However, when appropriately used, advance directives and POLST forms are helpful as advance care planning tools for expressing patient preferences.

An advance directive specifies who will make medical choices on the patient’s behalf if and when they become incapable of doing so. This document is also called “health care power of attorney.” It also offers direction or instructions for choosing medical care, usually in cases involving end-of-life care, and is also referred to as a “living will.” An advance directive is not a medical order but a directive or an authoritative instruction from the patient.

A POLST form, in contrast, consists of a list of medical directives that only apply to a specific patient population and deal with a small number of crucial medical choices. The form is meant to be used in conjunction with advance directives because it ensures continuity of care and acts as a translational tool.

An advance directive, sometimes known as a living will or health care power of attorney, is used to specify the types of treatments a patient may desire to receive in the event of a future, unforeseen medical emergency. It also allows patients to name a surrogate, and this is something every adult should have.

The POLST form is a portable medical order for specific medical care the patient would need immediately, depending on their diagnosis, prognosis and care goals. It has different names in different states, and POLST forms are suitable for people close to the end of their lives and with a severe illness or frailty.

POLST forms are suitable for people close to the end of their lives and with a severe illness or frailty.

It’s highly recommended the patient has an advance directive in place before requesting a POLST form. If patients participate in a POLST conversation, they can probably choose a surrogate. A POLST form can only be created, modified or revoked by the surrogate the patient specified in their advance directive if they ever lose the ability to make decisions themselves.

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