Quarterly Newsletter

Research and Quality Assurance Committee

The National POLST Form was created in 2019 following a multi-year process led by former National POLST Executive Director Amy Vandenbrouke, JD, and funded by the John A. Hartford Foundation and the Cambia Health Care Foundation. From the outset, the goal was for as many states as possible to adopt the form with minimal adaptation. Broad adoption of a common form offers important advantages, including reducing barriers to honoring POLST forms across state lines, simplifying the sharing of educational resources, ensuring alignment with national guidelines and best practices, and facilitating integration of POLST orders into electronic health records.

To lower barriers to state adoption, the original National POLST Form was designed to accommodate as many state-specific requirements as possible. Another key objective was to include language that discouraged inappropriate use of POLST while supporting correct interpretation of the medical orders. A tremendous number of people contributed to the creation of the first version, and it has since been adopted by multiple states with minimal adaptation. Over the past six years, it has proven durable and effective. Because the Form was always intended to evolve in response to emerging evidence and best practices, the NPC Research and Quality Assurance Committee (RQAC) was charged with reviewing and revising the form in 2024, its five-year anniversary.

The RQAC undertook a rigorous process of review, discussion, revision, and approval. Proposed revisions were released for public comment, after which the RQAC made additional refinements based on feedback received. The final POLST Form was approved and both the Form and the Guidance will be launched on the new National POLST Collaborative website in late January. 

First, revising a form that has been widely adopted and embedded in state policies, electronic medical record systems, websites, and educational materials creates significant downstream work. Changes should therefore be driven by clear evidence that they will improve POLST use, processes, or outcomes. Although the POLST evidence base has grown substantially, no current findings mandate structural changes to the Form. As a result, the RQAC focused on making targeted revisions to improve clarity, language, and intended use, while avoiding changes that would significantly alter the form’s structure or functionality.

Second, revision processes inevitably surface many well-reasoned—and often opposing—views. The RQAC benefited from members who had participated in the original Model Form development and could recall the rationale behind earlier decisions. Avoiding cyclical changes made and later reversed due to lost institutional memory was a priority. This consideration arose, for example, in the decision to replace the term “personal representative” with “surrogate decision maker.” Although debated extensively in the past, the Committee ultimately adopted the change because a national blue-ribbon panel had recommended the latter term, which has since been used consistently across National POLST Collaborative documents and policies. To preserve this institutional knowledge, the RQAC documented the rationale for each revision, with the intent that this record inform future updates.

Third, the original use of the term “personal representative” reflected the need to accommodate specific state statutory language. Although at least one such state ultimately did not adopt the National Form, this experience underscores a defining challenge of POLST: the form must function across an extraordinarily broad range of users and settings. These include patients and families, clinicians, long-term care facilities, emergency medical services, emergency departments, intensive care units, hospitals, outpatient clinics, post-acute care settings, as well as legal and judicial systems. Given these competing demands, it is not surprising that the National Form can feel complex or cumbersome at times—echoing the adage that “a camel is a horse designed by a committee.” Yet, considering the many contexts it must bridge, POLST remains a remarkable and uniquely powerful clinical tool.

In conclusion, the revised National POLST Form reflects the RQAC's attempts to be both responsive and restrained. The Committee sought to strengthen clarity, consistency, and intended use while honoring the substantial investment states have made in adopting and implementing the existing form. With that said, consideration should be given to having the Form re-designed through user-centered design processes and testing rather than expert review as simplifying the form is not best accomplished by a committee.       

The following people participated in the RQAC’s revision process:

Erik Fromme, MD (chair)

Pat Bomba, MD

Amelia Breyre, MD

Abby Dotson, PhD

Rebecca Gruszkos, LCSW (ad-hoc reviewer)

Marisette Hasan, RN

Susan Hickman, PhD

Montana Lucas, LMSW

Alvin Moss, MD

Karl Steinberg, ND

Donald Sullivan, MD

Kelly Vranas, MD

Neil Wenger, MD

Education Committee

The Education Committee is focused on delivering a National POLST form webinar with clear, branded content and CE accreditation. The committee will use the Texas form webinar script as a starting point for designing the content. The updated guidance manual will inform the script, speeding up content finalization. We are working to identify CE Accreditation resources to include webinar platform, the final platform decision will balance accessibility, cost, and compliance with CE guidelines. This education product is the primary focus of the committee until it has been produced.



A secondary priority for the committee is vetting state education for posting on the website. The Education Committee must review and approve state member education programs before sharing them on the national site to ensure consistency with standards. 

Committee Interest

Interested in getting more involved? Expressions of interest in committee or future Board service are welcome. Types of committees are Education, Forms Consultation, Technology, Research and Quality Assurance, Federal & State Policy Education.

The Collaborative is preparing to launch an updated website with significant enhancements, including:

• Expanded members-only learning resources
• Updated language translations and state-specific information
• A comprehensive review of 153 existing resources and links, resulting in updates or corrections to approximately half of all materials



These improvements are intended to enhance accessibility and usability for both clinicians and the public.

Check out the new National POLST Collaborative logo on this newsletter. This logo will be available for use in January and downloadable from polst.org.

A policy and guidance memorandum regarding the updated National POLST Collaborative logo will be released in the near future. While states are encouraged to align with the national logo, state autonomy is fully recognized, particularly given the complexities associated with rebranding. Consistent POLST messaging remains the highest priority.

New National POLST Collaborative Form and Guidance Updates

• The updated POLST form has been distributed to all members and will be publicly available in December
• Supporting materials will be added to the website on a rolling basis
• Translation efforts are ongoing, with a special thanks to Kōkua Mau for sharing translated materials in multiple languages.

Free Serious Illness Messaging Resources

The National POLST Collaborative encourages incorporating resources from the Serious Illness Messaging Toolkit to support consistent, patient-centered communication regarding serious illness, palliative care, and hospice care. These tools include evidence-based language and visual assets that members may adapt for their own organizational use.

In developing the website, the National POLST Collaborative was guided by these same principles to support clear, consistent, and patient-centered communication.

Member Feedback Survey

The National POLST Collaborative Member Feedback Survey closed recently. Here are the major findings!

Focus Areas: Members shared that quarterly meetings are most valuable when they focus on state-to-state learning, practical examples, and shared problem-solving. There is strong interest in hearing what is happening across states, learning from both long-standing and emerging programs, and receiving updates on POLST form revisions, research, and best practices. Members also value brief educational segments and opportunities for states to share their work during meetings.

Biggest Challenges: Funding remains the most significant challenge for state POLST programs, with many operating entirely through volunteer efforts and lacking administrative or educational support. Ongoing provider education was also highlighted as a critical need, particularly in light of high staff turnover, inconsistent POLST training requirements, and limited awareness of existing educational resources—especially in EMS and long-term care settings.

Members also noted challenges with consistent interpretation and use of POLST across care settings, resistance to electronic POLST and interoperability, and the need to sustain awareness among providers, patients, and the public. Looking ahead, members identified national priorities that include developing adaptable education and communication tools, supporting POLST technology solutions, providing clearer national guidance, and strengthening support for unfunded or resource-limited state programs.

We extend sincere appreciation to all members who contributed their time and insights!

Message Lab Grant Information

The National POLST Collaborative continues to participate in the Message Lab Grant, a national effort focused on improving how serious illness care and POLST are communicated across healthcare settings. The grant brings together leading organizations in serious illness care, palliative care, and advance care planning to align language, messaging, and tools. The grant period runs through September 2026, with a final group convening planned for Fall 2026.