Patterns of palliative care service consultation in a sample of critically ill ICU patients at high risk of dying.
Jennifer B Seaman, Amber E Barnato, Susan M Sereika and 2 others
PMID 27717509WHAT IT FOUND
Only 9.4% of high-risk ICU patients received palliative care consultation.
When it happened, it averaged 9 days into the stay. Most referrals were for goals of care, not symptom management. Bedside teams must integrate palliative principles earlier.
Key findings
01Palliative care consultation occurred in only 9.4% of high-risk ICU patients, and was significantly more frequent for those who died than those who survived.
02Consultations typically started late, averaging 9 days into the ICU stay, with 18% initiated the day before death or discharge and 21.9% on the day itself.
03The primary reason for consultation was clarifying goals of care (71%), far exceeding referrals for pain or symptom management (17.9%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study only counted formal specialist consultations, missing palliative care provided by the primary ICU team. Data relied on electronic health record documentation, which may be incomplete or inconsistent. The two hospitals had different staffing models (physician-led vs. nurse-led), making direct comparison difficult. The sample excluded patients who were not awake or communicative, potentially missing those who could not advocate for their own care. Both sites were in the same health system, limiting generalizability to other regions or hospital types.
Declared interests
None declared.
The easy way to misread this
Do not interpret the low consultation rate as evidence that these patients did not receive palliative care. The study only tracked formal specialist referrals, so bedside nurses and physicians providing comfort care, communication, and symptom management are not counted, meaning the actual delivery of palliative principles was likely much higher than the 9.4% figure suggests.