Case Management

What's the difference? Advance Directive versus POLST

Case Management Insider, August 11, 2015

Do you know the difference between an Advance Directive and a Physician Orders for Life Sustaining Treatment (POLST) form? You should says Peggy Rossi, BSN, MPA, CCM, a senior trainer/auditor for CA Health and Wellness and a consulting associate for the Center for Case Management in Wellesley, Massachusetts.
In the September issue of Case Management Monthly, Rossi talks about why it’s so important to use both when working with patients who are planning for end-of-life care.

The using a POLST form can help ensure that a patient’s wishes are followed by medical professionals and is complementary to but different from an Advance Directive, which allows patients to detail their wishes for end-of-life care.

To help distinguish between the two, Rossi put together this simple guide to help you understand the differences. The two types of forms should ideally both be used and can complement one another. For this reason case managers may want to encourage some of their patients to consider filling out both.

Advance Directive:

  • Written on plain white stationary 
  • Is best developed in a non-emergency situation
  • Is witnessed by two non-relatives and best if signed by a notary
  • For anyone over age 18 and is developed at any stage of wellness or illness
  • Provides instructions for future treatment
  • Does not guide emergency medical personnel
  • Guides inpatient treatment decisions when made available
  • An Advance Directive is an appropriate tool for persons who wish to make known to their loved ones any future end-of-life care wishes


  • Is printed on brightly colored paper (i.e., shocking pink or bright green)—while a bright color is not mandatory it does promote visibility and recognition
  • Is best developed in a non-emergency situation
  • To be legal the form must be signed by both the patient and physician, nurse practitioner or physician assistant
  • For persons with serious illness or frailty—at any age and in instances when a healthcare professional would not be surprised if the patient died within one year
  • Provides medical orders for current treatment
  • Guides actions by emergency medical personnel when made available
  • Guides inpatient treatment decisions when made available
  • Is an appropriate tool for these patients where their current health status indicates the need for standing medical orders

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