Scientific Article
BY Sarah Beth Harrington, MD FAAHPM; Heather Moore, MD;
Masil George, MD; David E. Smith, MD
Arkansas Physician Order for Life Sustaining
Treatment (POLST)
Abstract
The Physician Order for Life Sustaining
Treatment (POLST) is an advance care
planning tool for physicians caring for
patients with a life-limiting illness. Physicians
in Arkansas now have the ability to
document the treatment wishes of a patient
or surrogate on a POLST form, after having a
goals-of-care conversation. The POLST process
emphasizes advance care planning conversations
and informed, shared decision-making
about treatment wishes near the end of life
and ensures that those wishes are honored
across care settings.
Arkansas POLST
The POLST form was first introduced in
Oregon in 1994, and the POLST Paradigm
currently exists at some level in 50 states and
Washington, D.C. In the 2017 Arkansas legislative
session, Act 504 was signed into law. This
established the Arkansas Physician Order for
Life Sustaining Treatment (POLST) Act and
provided for use of a POLST form in Arkansas. 1
The POLST program encourages advance care
planning conversations between patients,
loved ones, and physicians; a POLST form
helps to document those wishes in a way that
will be honored across care settings.
A POLST form is an advance care planning
document that is designed for patients for
whom the physician would not be surprised
if the patient died in the next year. Patients
with a serious illness or frailty towards the
end of life are encouraged to discuss goals of
care with their clinician well before an acute
emergency near the end of life. A POLST form
is designed to document 1) code status and 2)
level of treatment a patient wants and should
always accompany a discussion with the patient’s
physician. There is also a “write-in”
portion where patients can document specific
wishes related to their care. Many choose to
use this portion to document interventions
such as feeding tubes or dialysis.
A POLST form can be completed by a patient
with capacity or a by a legal surrogate for
a patient without capacity. Once the form is
complete, it serves as a set of legal orders that
are honored across care settings. Research
shows that care transitions are common at
the end of life, especially for frail elders in
long-term care settings. 2-3 Once a POLST form
is completed, it stays with the patient and will
be honored across settings (nursing home,
home, ambulance, hospital, clinic, etc.).
Table 1: Key Differences between Advance Directives and POLST forms
Advance Directive
Arkansas POLST
Who needs one? All adults with capacity Patient with likely prognosis of
12 months or less
What are the components?
Who completes the
documentation?
Durable Power of Attorney for
Healthcare
Living Will
Patient with capacity
(must be witnessed or
notarized)
Is completion voluntary? Yes Yes
When is it active?
Serves as a guideline for future
care needs if the patient loses
decisional capacity
Is it associated with an order? No Yes
Can emergency personnel
follow?
Can it be changed or
rescinded?
No
Advance directives are not
orders
Yes, by the patient
The most recent, valid
documentation is considered
active
Order set describing
preferences for:
Cardiopulmonary resuscitation
(CPR)
Medical Interventions
Patient with Capacity or
Designated Surrogate
+
Arkansas-Licensed Physician
Dictates preferences for current
care
Serves as an active, durable
order honored across settings
Yes
Yes, by the patient or surrogate
Write VOID across the form.
Complete a new form with
updated preferences
62 • The Journal of the Arkansas Medical Society www.ArkMed.org