The Physician Orders for Life-Sustaining Treatment, (POLST) is a physician’s order that outlines a plan of serious illness care reflecting both a patient’s preferences concerning care at life’s end and a physician’s judgment based on a medical evaluation.   Its central aim is to allows a physician and patient to establish default orders concerning end of life care that can then be succinctly and clearly conveyed to other healthcare professionals, facilities, and emergency personnel when a patient is at home, in a long-term care facility, in transit between locations, entering an Emergency Department or being admitted into/discharged from an acute care facility. POLST is an important part of voluntary advance care planning and does not replace the need for an advance directive,  which is still necessary to name a heath care agent and preferences for future health states. Once competed and signed by a physician, POLST orders are required to be followed by health care professionals. 

The POLST form is completed by a patient’s physician or health care professional in collaborations with a physician, following a thorough conversation with the patient regarding the patient’s current and future health conditions and treatment preferences.  The physician signing the POLST is attesting that the order was discussed with the patient or representative and reflect the patient's known wishes.  A physician signature is required, and the patient's signature is optional but recommended.  If the patient lacks capacity to make medical decisions, the patient’s legally recognized decision-maker can participate in completing the POLST form.

A POLST should be offered to any patient, of any age, for whom death in the next 1-2 years would not be surprising.  This includes patients with metastatic cancer, advanced chronic disease, frailty, those having a terminal diagnosis, those receiving hospice or palliative care, and those who currently have or have had in the past DNAR status. 

Regulations instituting a POLST program have been adopted by the Alaska Department of Health and Social Services in 2021 with the implementation phase starting January 2022. Comfort One forms will still be honored indefinitely but will no longer be resupplied after June 2022. POLST forms, POLST program information, clinician, and family education and webinars are all available on the website akpolst.org. A POLST form can be printed on regular white paper and copies, electronic versions and photos of the form are legal and honored.