Outcomes for Hospitalized Patients with Comfort Measures Only Orders

Abstract

Background:

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.

Objectives:

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.

Design:

We completed a retrospective cross-sectional study of data from the electronic medical record.

Setting/Participants:

We assessed all adult patients with CMO orders admitted to four hospitals in the United States between 2022 and 2024.

Measurements:

We used descriptive statistics and multivariable logistic regression and linear regression models to identify the association of SPC and documented GOCC with patient outcomes.

Results:

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, p < 0.0001) and higher discharge with hospice (aOR 2.4, 95% CI 1.8–3.2, p < 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, p = 0.0004) and lower discharge with hospice (aOR 0.5, 95% CI 0.4–0.7, p = 0.0003).

Conclusions:

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.