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Outcomes for Hospitalized Patients with Comfort Measures Only Orders
Gina Piscitello1,2, Donna Durant1, Tami Minnier3
1Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Journal of Palliative Medicine
|June 8, 2026
Summary
Specialty palliative consults (SPC) were linked to lower in-hospital mortality and more hospice discharges for comfort measures only (CMO) patients. Documented goals of care conversations (GOCC) showed opposite associations, warranting further investigation.
Area of Science:
- Palliative Care
- End-of-Life Care
- Health Services Research
Background:
- Comfort Measures Only (CMO) orders prioritize patient comfort during the natural dying process.
- Understanding factors influencing outcomes for CMO patients is crucial for improving end-of-life care.
Purpose of the Study:
- To evaluate the association between specialty palliative consults (SPC) and documented goals of care conversations (GOCC) with in-hospital mortality and hospice discharge among patients with CMO orders.
Main Methods:
- Retrospective cross-sectional study utilizing electronic medical record data.
- Analysis included 6789 adult patients with CMO orders across four US hospitals (2022-2024).
- Multivariable logistic and linear regression models assessed the impact of SPC and GOCC on patient outcomes.
Main Results:
- SPC were associated with significantly lower in-hospital mortality (aOR 0.4) and higher discharge with hospice (aOR 2.4).
- Documented GOCC were associated with higher in-hospital mortality (aOR 1.8) and lower discharge with hospice (aOR 0.5).
- 73% of patients with CMO orders died in-hospital, and 22% were discharged with hospice.
Conclusions:
- Specialty palliative consults (SPC), not documented goals of care conversations (GOCC), were associated with improved outcomes (lower mortality, more hospice) for patients with CMO orders.
- Further research is needed to elucidate the mechanisms behind these differential associations.
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