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It has become mainstream, at least among health professionals. The original name, “physician orders for life-sustaining treatment,” is sometimes replaced by “portable medical orders” or
simply “POLST.” The National POLST office, which is leading efforts to standardize its dissemination and promote recommended national language for the states to follow, calls POLST a process
and a conversation as well as a form. POLST has a specific place in medical planning, adds Judy Thomas, CEO of the Coalition for Compassionate Care of California (CCCC), the home for
implementing POLST in California. In recent years CCCC has worked to standardize POLST statewide, she says. “We also got it established in statute, which has helped to make health care
providers more comfortable with it, knowing they were complying with the law.” CCCC has also developed training for health care providers on how to have conversations about POLST with
consumers and taught hundreds of people to go out and train others. POLST is becoming better known, and more people have seen it used for a loved one, Thomas says. California’s 2021–2022
budget included funds to develop a statewide electronic registry of POLST forms. In Oregon, with its three decades of experience with POLST, nearly half the people who die of natural causes
have a POLST form in that state’s electronic registry, password-protected and accessible to EMS personnel and emergency care physicians, says Susan W. Tolle, M.D., a professor of medicine
and director of the Center for Ethics at Oregon Health & Science University in Portland. “If we could encourage people to take a deep breath and step forward and say, ‘I really want to
talk about this,’ it could trigger conversations in their families. COVID is one more reason why we need to talk about it now,” she says. “It is a true gift if you can engage in advance care
planning, which would help your loved ones feel they know what you would want in a crisis and that they are doing what you would have wanted,” Tolle explains. “They won’t have to wake up at
2 a.m. and wonder if they did the right thing.” _Larry Beresford is a contributing writer and freelance medical journalist specializing in hospice, palliative care and hospital medicine.
His work has been published in_ Medscape and KevinMD_,_ _among other publications._
