A Rapid Review of States’ Portable Medical Order Forms and the National POLST Paradigm for Advanced Care Planning

Hospice and palliative care nurses initiate goals of care conversations with patients and family members while advocating for the completion of advance directives. As leaders in these conversations, nurses must have a working knowledge of the various forms, such as portable medical orders. The National Physician Orders for Life-Sustaining Treatment (POLST) Paradigm calls for the standardization of portable medical orders to ensure goal-concordant care that can cross all healthcare settings. This rapid review provides an overview of state-level portable medical order forms, compares and contrasts them with the National POLST form, and proposes policy recommendations for hospice and palliative care nurses to advocate within their state, territory, or tribal nation. Portable medical order forms were obtained from governmental websites, and data were extracted systematically, with the National POLST form serving as the template. Only 5 states use the National POLST form, and the other 46 demonstrate wide variations in form structure, sequence of orders, and level of specificity for treatment options. No portable medical orders were identified for US territories and tribal nations. Hospice and palliative care nurses can utilize the results of this rapid review to advocate for legislative changes, such as reordering treatment options, integrating rather than always starting with high-intensity care.