• Susan E Hickman and Rebecca Critser.
• 1 Department of Community and Health Systems, Indiana University School of Nursing , Indianapolis, Indiana.
• J Palliat Med. 2018 Jul 1; 21 (7): 978-986.

BackgroundThe Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is used across the country to document the treatment preferences of seriously ill or frail patients as medical orders. The National POLST Paradigm Task Force maintains consensus-based standards for POLST programs and uses these to determine whether a state POLST program is developing, endorsed, or mature.ObjectivesTo evaluate state program form adherence to national standards.DesignDocument review.MeasurementsForms from endorsed/mature (n = 21) and developing (n = 23) states were compared with national standards to assess adherence to required and optional form elements.ResultsRequired elements were present on 84% of endorsed/mature state POLST forms and 73% of the developing state POLST forms. Compliance with required elements in endorsed states ranged from 50% to 100%. Three endorsed/mature states (14%) had forms that met all of the required elements fully and 14 (67%) had forms that met the all of the elements fully or partially.ConclusionsThere is variability in adherence to required and optional standards as well as challenges in interpreting and applying existing standards. Although there may be legal and logistical barriers to the existence of a national POLST form, standardization remains an important goal to support patient-centered care.

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