Extending Specialty Palliative Care’s Reach: The Use of Comfort Care Order Sets

Key Message : Comfort care order sets (CCO) can extend specialty palliative care (SPC)’s reach. Annually 80% of inpatients who died received CCO, while SPC consultation decreased. CCO plus SPC was more common for younger patients, English speakers, and cancer patients, and associated with more social work and chaplain involvement, highlighting care gaps.

Abstract: Background/Rationale: Specialty palliative care (SPC) improves care for people with serious illness, but the need for SPC services outstrips supply.1,2 Use of comfort care order sets (CCO), a standardized, linked collection of medications, nursing orders, and consultations, may extend SPC’s expertise by guiding clinicians caring for patients at end of life.3,4

Objectives/

Purpose: We examined the use of CCO over time and compared differences in the characteristics of those who received CCO with and without SPC consultation.

Methods/Approach: A cross-sectional, retrospective study of 10 years of CCO use at an academic medical center. Electronic health record search identified inpatients with a CCO and their demographic data, diagnosis, disposition (alive/dead), and presence of social work or chaplain notes and SPC consultation. We calculated descriptive data comparing patients with and without SPC consultation and examined CCO use annually for patients who died.

Results: Overall, 7713 patients had CCO over 10 years, of whom 44.5% also received SPC consultation. Those with SPC consultation were younger (64.7 vs. 71.1 years, p<.001), less likely to die inpatient (75% vs. 81%, p<.001), and more likely to have notes by social workers (37% vs. 33%%, p<.001) and chaplains (80% vs. 77%, p<.001). English speakers (47% vs. 37%, p<.001) and those with cancer (65% vs. 40%, p<.001) were most likely to receive SPC. Among 7522 inpatients who died, approximately 80% annually (79% to 81%, p=.04) received CCO. However, those also receiving SPC decreased over time (48% to 32%, p<.001).

Conclusion/Implications: Among inpatients receiving CCO, SPC was consulted more often for younger patients, English speakers, and those with cancer. Patients with both CCO and SPC consultation were more likely to have social work and chaplain notes, identifying potential gaps in care. While CCO use remained stable over time, declining SPC consultation suggests CCO may increasingly substitute for SPC involvement.

References: 1. Peeler A, Afolabi OA, Sleeman KE, et al. Confronting global inequities in palliative care. BMJ Glob Health. 2025;10(5):e017624. doi:10.1136/bmjgh-2024-017624
2. Kavalieratos D, Corbelli J, Zhang D, et al. Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis. JAMA. 2016;316(20):2104-2114. doi:10.1001/jama.2016.16840
3. Jarabek B, Jama A, Cha S, Ruegg S, Moynihan T, McDonald F. Use of a palliative care order set to improve resident comfort with symptom management in palliative care. Palliat Med. 2008;22(4):343-349. doi:10.1177/0269216308090169
4. Warmels G, Roberts A, Haddad J, Chomienne MH, Bush SH, Gratton V. Comparing Adherence with Best Practices in End-of-Life Care After Implementing the End-of-Life Order Set: A Quality Improvement Project in an Ottawa Academic Hospital. Palliative Medicine Reports. 2023;4(1):100-107. doi:10.1089/pmr.2022.0070