Trigger-Based Referral and Needs Assessment in the Intensive Care Unit: A Narrative Review and Conceptual Synthesis

Background/Objectives: Trigger-based referral systems are widely used to identify intensive care unit (ICU) patients who may benefit from palliative care, but the extent to which trigger status corresponds to multidimensional patient and family need remains uncertain. This narrative review examines trigger-based referral, needs assessment, and integrated approaches to ICU palliative care. Methods: PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and reference lists were searched, and a purposive thematic synthesis was conducted. The original identification-stage record counts were unavailable; selection was reconstructed from an archived full-text library, and screening was primarily performed by one author. Results: Trigger-based systems improved recognition of clinically vulnerable patients and several care processes. Direct evidence comparing trigger status with measured need is limited, however, and derives principally from one multicenter study using a family-member-reported NEST score. The literature supports distinguishing clinical risk from measured need but does not establish the superiority of trigger-based, needs-based, or integrated models. Conclusions: Current evidence supports comparative testing rather than adoption of any integrated configuration. Candidate components, timing, thresholds, feasibility, and applicability across healthcare systems require prospective evaluation.