Oregon POLST Resources

Laws and Regulations related to POLST Use in Oregon

Neither the Oregon POLST Program nor the form was created through legislation. Instead, Oregon used a “grassroots approach” to garner clinical consensus and to integrate and establish POLST as the standard of care. – See our Timeline.

In 1999, the Oregon Medical Board changed its administrative rule defining the scope of practice for EMTs/First Responders, requiring such emergency personnel to respect POLST forms (OAR 847-035-0030(6)). The rule states:

An Oregon-certified First Responder or EMT, acting through standing orders, shall respect the patient’s wishes including life-sustaining treatments. Physician supervised First Responders and EMTs shall request and honor life-sustaining treatment orders executed by a physician, nurse practitioner or physician assistant if available. A patient with life-sustaining treatment orders always requires respect, comfort and hygienic care.

Physicians and Physician Assistants are required by Oregon Administrative Rules to honor POLST forms (OAR 847-010-0110). The rule states:

(1) A physician or physician assistant licensed pursuant to ORS Chapter 677 shall respect the patient’s wishes including life-sustaining treatments. Consistent with the requirements of ORS Chapter 127, a physician or physician assistant shall respect and honor life-sustaining treatment orders executed by a physician, physician assistant or nurse practitioner. The fact that a physician, physician assistant or nurse practitioner who executed a life-sustaining treatment order does not have admitting privileges at a hospital or health care facility where the patient is being treated does not remove the obligation under this section to honor the order. In keeping with ORS Chapter 127, a physician or physician assistant shall not be subject to criminal prosecution, civil liability or professional discipline.

(2) Should new information on the health of the patient become available the goals of treatment may change. Following discussion with the patient, or if incapable their surrogate, new orders regarding life-sustaining treatment should be written, dated and signed.

Expectations of DSPs (Direct Support Professionals) Supporting Individuals in 24-Hour Residential Program Settings when there is a POLST (Portable Orders for Life-Sustaining Treatment) or DNR (Do Not Resuscitate). 2020.02.07 ODDS New Policy Transmittal pt20011

Print Materials for Laypersons

Print Materials for Professionals

Videos for Laypersons

Videos for Professionals

Educational Tools

Standard Presentations for Specific Audiences as PDFs

If you or your facility is interested in using any of these Oregon POLST presentations, please contact the POLST program (polst@ohsu.edu) for the PowerPoint version (including any available faculty notes).

POLST related Factsheets & Articles

Office of the National Coordinator for Health Information Technology

Scholarly & Other Publications

Gievers L, Khaki S, Dotson A, Chen Z, Macauley RC, Tolle SW. Social Determinants of Health May Predict End of Life Portable Orders for Life Sustaining Treatment Form Completion and Treatment Selections. Am J Hospice and Palliat Med. Sept 2021. doi:10.1177/10499091211041566.

Vranas KC, Plinke W, Bourne D, Kansagara D, Lee RY, Kross EK, Slatore CG, Sullivan DR. The influence of POLST on treatment intensity at the end of life: A systematic review. J Am Geriatr Soc. 2021; 1- 14. doi:10.1111/jgs.17447.

Tolle SW, Dotson A, Ferrell B. The Expanding Role of Nurse Practitioners in the Completion of Oregon Portable Orders for Life-Sustaining Treatment. J Palliat Med. 2021 Aug 17. doi.org/10.1089/jpm.2021.0386. [Epub ahead of print].

Tolle SW. Aligning POLST Orders with Wishes: Time to Put Evidence into Practice. J Am Geriatr Soc. 2021 March 18. 2021;69:1801 – 1804. doi/10.1111/jgs.17150.

Lori A. Constantine, DNP, Kesheng Wang, PhD, Danielle Funk, MS, Atticus Speis, MS, and Alvin H. Moss, MD. Use of a State Registry to Compare Practices of Physicians and Nurse Practitioners in Completing Physician Orders for Life-Sustaining Treatment Forms. J Palliat Med. 2020 Dec 1. doi.org/10.1089/jpm.2020.0515.

Tark A, Song J, Parajuli J, Chae S, Stone PW. Are We Getting What We Really Want? A Systematic Review of Concordance Between Physician Orders for Life-Sustaining Treatment (POLST) Documentation and Subsequent Care Delivered at End-of-Life. Am J Hospice and Palliat Med. 2020 Nov 28. doi:10.1177/1049909120976319.

Lee, R.Y., Modes, M.E., Sathitratanacheewin, S., Engelberg, R.A., Curtis, J.R. and Kross, E.K. Conflicting Orders in Physician Orders for Life‐Sustaining Treatment Forms. J Am Geriatr Soc. 2020 Sept. 16. doi:10.1111/jgs.16828.

Macauley, R., & Tolle, S. POLST Signature Requirements: Responding With Compassion While Ensuring Informed Consent. Am J Hospice and Palliat Med. 2020 Sept 1. doi: 10.1177/1049909120953084.

Lee RY, Brumback LC, Sathitratanacheewin S, et al. Association of Physician Orders for Life-Sustaining Treatment with ICU admission among patients hospitalized near the end of life. JAMA. 2020 Feb 16. doi: 10.1001/jama.2019.22523. [Epub ahead of print].

Rubins, J.B. Underutilization of Portable Orders for Life-Sustaining Treatment at Discharge from Hospital: Observational Study at US Academic Trauma Center. J Gen Intern Med. 2020 Feb 10. https://doi.org/10.1007/s11606-020-05698-1.

Ballou JH, Dewey EN, Zonies DH. Elderly patients presenting to a Level I trauma center with Physician Orders for a Life-Sustaining Treatment form: A propensity-matched analysis. J Trauma Acute Care Surg. 2019 July 1. doi: 10.1097/TA.0000000000002321.

Zive D, Newgard CD, Lin A, Caughey AB, Malveau S, Eckstrom E. Injured Older Adults Transported by Emergency Medical Services: One Year Outcomes by POLST Status. Prehosp Emerg Care. 2019 May 29. doi: 10.1080/10903127.2019.1615154. [Epub ahead of print].

Vranas KC, Lin AL, Zive D, Tolle SW, Halpern SD, Slatore CG, et al. The Association of Physician Orders for Life-Sustaining Treatment With Intensity of Treatment Among Patients Presenting to the Emergency Department. Ann Emerg Med. 2019 June 24. https://doi.org/10.1016/j.annemergmed.2019.05.008. [Epub ahead of print]

Blix F, Tolle SW. POLST: Co-Piloting, Not Hijacking, the Advance Directive. NAELA J. 2019 June. https://www.naela.org/NewsJournalOnline/OnlineJournalArticles/OnlineJune2019/POLSTBlixTolle.aspx. [Epub ahead of print].

Jimenez VM, Dotson A, Tolle SW. Response to Tark et al.: Variations in Physician Orders for Life-Sustaining Treatment Program across the Nation: Environmental Scan. J Palliat Med. 2019 Apr 22. doi: 10.1089/jpm.2019.0181. [Epub ahead of print]

GAO. (February 2019). ADVANCE CARE PLANNING: Selected States’ Efforts to Educate and Address Access Challenges (GAO-19-231). U.S. Government Accountability Office: Washington, DC.

Nugent SM, Slatore CG, Ganzini L, Golden SE, Zive D, Vranas KC, Sullivan D. POLST Registration and Associated Outcomes Among Veterans With Advanced-Stage Lung Cancer. Am J Hosp Palliat Care. 2019 Jan 30. doi: 10.1177/1049909118824543. [Epub ahead of print]

Tolle SW, Jimenez VM, Eckstrom E. It is Time to Remove Feeding Tubes From POLST Forms. J Am Geriatr Soc. 2019 Mar;67(3):626-628. doi: 10.1111/jgs.15775. Epub 2019 Jan 31.

Zive DM, Jimenez VM, Fromme EK, Tolle SW. Changes Over Time in the Oregon Physician Orders for Life-Sustaining Treatment Registry: A Study of Two Decedent Cohorts. J Palliat Med. 2018 Nov 21. doi: 10.1089/jpm.2018.0446. [Epub ahead of print]

Tolle SW, Teno JM. Counting POLST Form Completion Can Hinder Quality. Health Affairs Blog, July 19, 2018. DOI:10.1377/hblog20180709.244065

ONC. (2018). Electronic End-of-Life and Physician Orders for Life-Sustaining Treatment (POLST) Documentation Access through Health Information Exchange (HIE). Office of the National Coordinator for Health Information Technology: Washington, DC.

Moss AH, Zive DM, Falkenstine EC, Dunithan C. The Quality of POLST Completion to Guide Treatment: A 2-State Study. J Am Med Dir Assoc. 2017 Sep 1;18(9):810.e5-810.e9. doi: 10.1016/j.jamda.2017.05.015. Epub 2017 Jun 28.

Lammers A, Zive DM, Tolle SW, Fromme EK. The Oncology Specialist’s Role in POLST Form Completion. Am J Hosp Palliat Care. 2018 Feb;35(2):297-303. doi: 10.1177/1049909117702873. Epub 2017 Apr 16.

Tolle SW, Teno JM. Lessons from Oregon in Embracing Complexity in End-of-Life Care. N Engl J Med. 2017 Mar 16;376(11):1078-1082. doi: 10.1056/NEJMsb1612511.

Hayes SA, Zive D, Ferrell B, Tolle SW. The Role of Advanced Practice Registered Nurses in the Completion of Physician Orders for Life-Sustaining Treatment. J Palliat Med. 2017 Apr;20(4):415-419. doi: 10.1089/jpm.2016.0228. Epub 2016 Oct 21.

Zive DM, Cook J, Yang C, Sibell D, Tolle SW, Lieberman M. Implementation of a Novel Electronic Health Record-Embedded Physician Orders for Life-Sustaining Treatment System. J Med Syst. 2016 Nov;40(11):245. Epub 2016 Oct 1.

Zive DM, Fromme EK, Schmidt TA, Cook JNB, Tolle SW. Timing of POLST Form Completion by Cause of Death. J Pain Symptom Manage. 2015;50(5):650-658.

Fromme EK, Zive D, Schmidt TA, Cook JNB, Tolle SW. Association Between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and In-Hospital Death in Oregon. J Am Geriatr Soc. 2014 Jul;62(7):1246-51. doi: 10.1111/jgs.12889. Epub 2014 Jun 9.

Schmidt TA, Olszewski Hunt EA, Zive D, Fromme EK, Tolle, SW. In Response to Letter to the Editor. J Emerg Med. http://dx.doi.org/10.1016/j.jemermed.2014.07.057. Epub 2014 Dec 26.

Schmidt TA, Zive D, Fromme EK, Cook JNB, Tolle SW. Physician Orders for Life-Sustaining Treatment (POLST): Lessons learned from analysis of the Oregon POLST Registry. Resuscitation. 2014 Apr;85(4):480-5. doi: 10.1016/j.resuscitation.2013.11.027. Epub 2014 Jan 6.

Richardson DK, Fromme EK, Zive D, Fu R, Newgard CD. Concordance of Out-of-Hospital and Emergency Department Cardiac Arrest Resuscitation With Documented End-of-Life Choices in Oregon. Ann Emerg Med. 2014 Apr;63(4):375-83. doi: 10.1016/j.annemergmed.2013.09.004. Epub 2013 Nov 6.

Schmidt TA, Olszewski EA, Zive D, Fromme EK, Tolle SW. The Oregon POLST Registry: A Preliminary Study of Emergency Medical Services Utilization. J Emerg Med. 2013 Apr;44(4):796-805. doi: 10.1016/j.jemermed.2012.07.081. Epub 2013 Jan 16.

Olszewski EA, Newgard CD, Zive D, Schmidt TA, McConnell KJ. Validation of Physician Orders for Life-Sustaining Treatment: Electronic Registry to Guide Emergency Care. J Am Geriatr Soc. 2012 Jul;60(7):1384-6. doi: 10.1111/j.1532-5415.2012.04027.x.

Fromme EK, Zive D, Schmidt TA, Olszewski EA, Tolle SW. POLST Registry Do-Not-Resuscitate Orders and Other Patient Treatment Preferences. JAMA. 2012 Jan 4;307(1):34-5. doi: 10.1001/jama.2011.1956.

Hickman SE, Nelson CA, Moss AH, Tolle SW, Perrin NA, Hammes BJ. The Consistency between treatment provided to nursing facility residents and orders on the physician orders for life-sustaining treatment form. J Am Geriatr Soc. 2011 Nov;59(11):2091-9. doi: 10.1111/j.1532-5415.2011.03656.x. Epub 2011 Oct 22.

Hickman SE, Nelson CA, Perrin NA, Moss AH, Hammes BJ, Tolle SW. A comparison of methods to communicate treatment preferences in nursing facilities: Traditional practices versus the physician orders for life-sustaining treatment program. J Am Geriatr Soc. 2010 Jul;58(7):1241-8. doi: 10.1111/j.1532-5415.2010.02955.x.

Hickman SE, Nelson CA, Moss AH, Hammes BJ, Terwilliger A, Jackson A, Tolle SW. Use of the Physician Orders for Life-Sustaining Treatment (POLST) paradigm program in the hospice setting. J Palliat Med. 2009 Feb;12(2):133-41. doi: 10.1089/jpm.2008.0196.

Hickman SE, Sabatino CP, Moss AH, Nester Wehrle J. The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation. J Law Med Ethics. 2008 Spring;36(1):119-40, 4. doi: 10.1111/j.1748-720X.2008.00242.x.

Hickman SE, Hammes BJ, Moss AH, Tolle SW. Hope for the Future: Achieving the Original Intent of Advance Directives. Hastings Cent Rep. 2005 Nov-Dec;Spec No:S26-30.

Hickman SE, Tolle SW, Brummel-Smith K, Carley MM. Use of the physician orders for life-sustaining treatment program in Oregon nursing facilities: Beyond resuscitation status. J Am Geriatr Soc. 2004 Sep;52(9):1424-9.

Schmidt TA, Hickman SE, Tolle SW, Brooks HS. The physician orders for life-sustaining treatment program: Oregon emergency medical technicians’ practical experiences and attitudes. J Am Geriatr Soc. 2004 Sep;52(9):1430-4.

Lee MA, Brummel-Smith K, Meyer J, Drew N, London MR. Physician Orders for Life-Sustaining Treatment (POLST): Outcomes in a PACE Program. J Am Geriatr Soc. 2000 Oct;48(10):1219-25.

Tolle SW, Tilden VP. Changing End-of-Life Planning: The Oregon Experience. J Palliat Med. 2002 Apr;5(2):311-7.

Tolle SW, Tilden VP, Nelson CA, Dunn PM. A prospective study of the efficacy of the physician order form for life-sustaining treatment. J Am Geriatr Soc. 1998 Sep;46(9):1097-102.

Dunn PM, Schmidt TA, Carley MM, Donius M, Weinstein MA, Dull VT. A method to communicate patient preferences about medically indicated life-sustaining treatment in the out-of-hospital setting. J Am Geriatr Soc. 1996 Jul;44(7):785-91.