Outcomes for Hospitalized Patients with Comfort Measures Only Orders.

Abstract

Clinicians place comfort measures only (CMO) orders for hospitalized patients at the end-of-life when a decision has been made to focus on patient comfort and allow the natural dying process to occur. Our primary aim was to assess the associations of specialty palliative consults (SPC) or documented goals of care conversations (GOCC) with in-hospital mortality among patients with CMO orders. We completed a retrospective cross-sectional study of data from the electronic medical record. We assessed all adult patients with CMO orders admitted to four hospitals in the United States between 2022 and 2024. We used descriptive statistics and multivariable logistic regression and linear regression models to identify the association of SPC and documented GOCC with patient outcomes. Of 6789 hospitalized patients with CMO orders, 48% were female, and these patients had median age 71 years. Seventy-three percent died in-hospital, and 22% were discharged with hospice. SPC placed anytime during hospital admission were associated with lower in-hospital mortality (aOR 0.4, 95% CI 0.3-0.6, <i>p</i> < 0.0001) and higher discharge with hospice (aOR 2.4, 95% CI 1.8-3.2, <i>p</i> < 0.0001). In contrast, documented GOCC anytime during admission were associated with higher in-hospital mortality (aOR 1.8, 95% CI 1.3-2.4, <i>p</i> = 0.0004) and lower discharge with hospice (aOR 0.5, 95% CI 0.4-0.7, <i>p</i> = 0.0003). For patients with CMO orders, SPC, rather than documented GOCC, were associated with lower in-hospital mortality and higher receipt of hospice. Future research should explore reasons why only SPC, and not documented GOCC, were associated with these findings.