​Patients and their proxies "may believe that…documenting some, but not all, of their wishes on the MOLST [medical orders for life-sustaining treatment] form is sufficient for directing their end-of-life care," write researchers in a January 2017 Journal of the American Medical Directors Association article. However, "the result of making some, but not all, choices, may result in patients receiving undesired, extraordinary, or invasive care." The authors begin by pointing out the discrepancies in the names of the form, which range from MOLST to POLST (physicians' orders for life-sustaining treatment), to state variations, such as Iowa's IPOST (Iowa physician orders for scope of treatment). The authors also note confusion among these forms, living wills, and do-not-resuscitate orders. Therefore, they set out to clarify how well patients understand the meaning of the decisions included on these forms. After retroactive review of 100 forms for emergency department (ED) patients, researchers found that most (69%) were left incomplete. They also found seeming inconsistencies, such as when patients opted for "comfort measures only," but then also requested hospital care, intravenous fluids, and antibiotics. Additionally, the authors note that forms filled out by proxies were not different from those filled out by patients in rates of requested orders or level of care.

HRC Recommends: When the need arises to follow a patient's wishes for end-of-life care, families and providers must communicate to ensure the patient's wishes are followed and clarify any areas of ambiguity. Providers must receive appropriate training and education to prepare them to lead such discussions. Patients' and family members' decisions must be communicated to all members of the care team to ensure that their decisions are respected.