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Advance directives are legal documents that outline an individual's preferences regarding major medical decisions. These directives specify the healthcare options that an individual desires or rejects, currently and in the future. In addition, advance directives designate one or more individuals who will act as spokespersons on behalf of the patient if they become unable to communicate their preferences. There are variations in advance directive laws from state to state. Several states have implemented specific forms of advance directives, such as Physician Orders for Life-Sustaining Treatment (POLST), Medical Orders for Life-Sustaining Treatment (MOLST), Medical Orders for Scope of Treatment (MOST), Physician Orders for Scope of Treatment (POST), Do-Not-Resuscitate (DNR) Order/Clinician Orders for Life-Sustaining Treatment (COLST), Transportable Physician Orders for Patient Preferences (TPOPP), or similar directives have been introduced. These forms condense the essential elements of an advance directive into a medical order format.[1] To maintain brevity, the term "POLST" will be applied to encompass all the variations above in the remainder of this article.
Physicians, nurse practitioners, physician assistants, nurses, social workers or counselors, chaplains, and other healthcare professionals should regularly discuss advance directives with their patients. Each discipline brings unique skills and expertise that can work together and contribute toward improved patient outcomes. These discussions should ideally occur before the onset of an acute illness and should be revisited or updated periodically to ensure alignment with the patient's wishes. Numerous medical and surgical specialty societies recommend the inclusion of advance directives and goals of care discussions in their clinical practice guidelines. It is considered a good practice to inquire about advance directives upon hospital admissions and annual wellness visits, particularly for the senior population or individuals with life- or capacity-limiting diagnoses.[19][20][21]