[4] It is immediately recognizable and can be used by doctors and first responders (including paramedics, fire departments, police, emergency rooms, hospitals and nursing homes).
Comparing to documents like DNI (Do Not Intubate), DNR (Do Not Resuscitate) and advance directive, the POLST form provides more information on the types of end-of-life treatment or intervention that the severely ill wishes to receive.
[5] Organizations that have passed formal resolutions in support of POLST include the American Bar Association[6] and the Society for Post-Acute and Long-Term Care Medicine[7] (AMDA).
[19] In a 2006 consensus report, the National Quality Form observed that "compared with other advance directive programs, POLST more accurately conveys end-of-life preferences and yields higher adherence by medical professionals."
The National Quality Forum and other experts have recommended nationwide implementation of the POLST paradigm [20] Implementation of POLST was also recently recommended by the National Academy of Sciences Institute of Medicine in its report, "Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life."
The POLST form generally has sections for the individual to decide whether or not they would want cardiopulmonary resuscitation (CPR), the preferred level of medical interventions, or whether they would want artificially administered nutrition.
A study on nursing home residents has shown the high rate that the medical teams respected peoples’ wishes and gave the treatments according to the orders on section B.
[23] Before executing the orders on the POLST form, the provider should talk with individuals with decision-making capacity to obtain the most updated wishes.
[5] This process or conversation could involve families and relevant care providers as well to ensure people are well-informed while making the decisions.
[5] If the individual has made changes to the POLST form, the provider is responsible for explaining how the updates will likely impact future treatment plans.
[5] An advance directive is a legal document that allows individuals to share their wishes with their health care team during a future medical emergency.
[15] Typically, if a provider believes that a person's condition will increasingly worsen and make it hard for the individual to survive another year, then a POLST Form is used.
[24] A POLST form turns a person's treatment wishes outlined in an advance directive into medical orders.
[25] The POLST Form provides explicit guidance to healthcare professionals under predictable future circumstances based on the individual's current medical condition.
According to Gundersen lutheran Health System, after they have adopted POLST, about $3000 to $6000 is reduced at the cost for each person because the hospital does not need to use medical devices or interventions to support their lives after they select “comfort measures” on the form.
[21] In addition, the formal document is a standard medical order signed by physicians and it is legal and effective in various healthcare settings and states.
[5] Some studies have shown that the providers were less likely to give aggressive treatments to individuals with DNR/DNI even if they are not critically ill. A study on nursing home residents has found that most residents with DNR order marked on POLST forms that they would like to have treatments, which indicates that DNR orders do not convey individual’s ideas and POLST is a better tool in communication.
[5] Conservative groups like the Media Research Center and the Catholic Medical Association argue that there will be unintended consequences or potential abuses fostered by POLST adoption.
Any document determining an individual's quality of care or life-ending choices carries moral and ethical dilemmas, and POLST instruments (or the protocols and circumstances through which they are explained to people) have been criticized for this by the Catholic Medical Association.