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Advance Directives vs. POLST Both advance directives and POLST forms are advance care plans. They complement each other but work in different ways. All adults with capacity should have an advance directive documenting a Health Care Power of Attorney (HCPOA) and a Living Will. An advance directive serves as a guide for when a patient can no longer make decisions for him or herself. Only patients with a limited life expectancy (<1 year) are eligible for a POLST. Both patients with capacity and surrogates for patients without capacity can complete a POLST, which serves as an actionable order set. Table 1 summarizes the differences between the two documents. Ethics Surrounding POLST The POLST Act recognizes that allowing natural death to occur is not the same as actively hastening death. POLST forms do not allow for euthanasia or physician-assisted suicide. Completing a POLST form is voluntary and should be done in conjunction with a goals-of-care conversation with a physician. A POLST can be voided or changed at any time, and physicians should review the form and goals of care with a patient or their surrogate periodically to confirm that goals are still the same. Practical Guide for Arkansas Physicians POLST is a state-specific form. Hospitals or other institutions may elect to honor out-ofstate forms, which should be described in institutional policy. We recommend that physicians encourage completion of an Arkansas POLST if a patient has a POLST form from another state. Physicians are encouraged to have discussions with their patients with a limited life expectancy about diagnosis, prognosis, and goals of treatment in a shared decision-making model. Completing a POLST form with the patient or surrogate can ensure that the patient’s wishes will be honored. The Arkansas POLST form (Figure 1), with directions, can be accessed through the Arkansas Department of Health’s webpage (https:// www.healthy.arkansas.gov/programs-services/topics/polst). The webpage also contains a webinar about Arkansas POLST and links to informational videos for self-directed learning. The website has an email link for health care providers to reach out to the state’s POLST Committee with questions. The National POLST Paradigm is also a valuable resource for clinicians and patients or caregivers (www. POLST.org). For physicians who are caring for veterans in the VA Healthcare System (Central Arkansas Veterans Healthcare System [CAVHS]), the Veterans Healthcare System of the Ozarks, and all VA-affiliated clinics), it is important to note the VA launched a complementary advance care planning process in January 2018. The Life Sustaining Treatment Decisions Initiative (LSTDI) is a nationwide VA program created to facilitate conversations between health care teams and seriously-ill veterans regarding goals of care and options for life-sustaining Figure 1. treatment. Nationally, the VA standardized the documentation and orders related to a Veteran’s preferences for life-sustaining treatments. Like Arkansas POLST, the LSTDI allows health care teams to document the care wishes of veterans as well as their preferences for life-sustaining treatments like mechanical ventilation, artificial nutrition and hydration, hospitalization, and ICU care. However, there are important differences between this process and Arkansas POLST. First, the LSTDI documentation and orders are only active within a VA setting. Veterans require additional documentation for use in the community. We recommend the use of an Arkansas POLST form. Second, advance practice nurses, physician assistants, and Volume 117 • Number 3 SEPTEMBER 2020 • 63