Palliative Care Consultation Team Research Articles

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

Patients facing serious or life-threatening illnesses account for a disproportionately large share of Medicaid spending. We examined 2004-07 data to determine the effect on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals. On average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care. These reductions included $4,098 in hospital costs per admission for patients discharged alive, and $7,563 for patients who died in the hospital. Consistent with the goals of a majority of patients and their families, palliative care recipients spent less time in intensive care, were less likely to die in intensive care units, and were more likely to receive hospice referrals than the matched usual care patients. We estimate that the reductions in Medicaid hospital spending in New York State could eventually range from $84 million to $252 million annually (assuming that 2 percent and 6 percent of Medicaid patients discharged from the hospital received palliative care, respectively), if every hospital with 150 or more beds had a fully operational palliative care consultation team.

Description of a Tertiary Swiss University Hospital Palliative Population Based on the International Classification of Disease (ICD): A Retrospective Pilot Study

The factors for assessing the utilization rate of a palliative care service are various and complex. Several authors have described different methods to address this problem. McNamara and colleagues have proposed criteria to determine "minimal," "mid-range," and "maximal" palliative population estimates. In order to evaluate the utilization of our intrahospital palliative care consult team (PCT), it appeared necessary to better describe and define the population who dies in our institution, a Swiss university hospital. The goal of this pilot study was to determine what percentage of patients who died in our hospital over a 4-month period in 2007 was seen by the palliative care consult team (PCT), using "minimal" and "maximal" population estimates. The hospital database was searched for all adult patients who died during that period and the "maximal" and "minimal" populations determined. The PCT's database was searched to identify those patients who had been seen by the PCT. The charts of a random sample of patients who did not initially meet the "minimal" criteria were hand searched. A total of 294 adult deaths were reported: 263 (89%) met the "maximal" criteria and 83 (28%) met the "minimal" criteria initially. The random search of 56 charts of the 180 patients who did not meet the "minimal" criteria revealed that 21 (38%) should have been included in the "minimal" population. The PCT saw 67/263 (25.5%) of the "maximal" palliative patient population and 56/151 (37.1%) of the "minimal" palliative population. This study highlights the usefulness of the method proposed by McNamara and colleagues to determine palliative populations. However, it also illustrates an important limitation of the "minimal" estimate and reliance on the accuracy of the cause of death as noted on the death certificate. A strategy to address this limitation is suggested. The "maximal" estimate suggests that the PCT is being underutilized.

Comparison of Hospice Eligible (HE) Versus Hospice Ineligible (HI) Patients Admitted to a Medical Service: A Retrospective Study (706)

1.Review Hospice Eligibity Criteria.2.Describe the percentage of medical service patients who are hospice eligible on admission.3.Describe the resource use and survival of patients who were HE and HI at the time of admission to the Medical Service of a VA Medical Center. Background. Referral criteria for palliative care consultations remain unclear. Research objectives. Examine what proportion of patients admitted to a medical service are hospice eligible (HE), and associated differences in resource use and survival. Methods. The electronic charts of 93 patients consecutively admitted to the medical service at a VA medical center in October 2004, were reviewed for HE, demographics, resource utilization, and survival. HE was determined by the National Hospice Palliative Care Organization guidelines. In 2004, palliative care consultation teams were being established. Results. Ninety-three charts were reviewed. Median age was 70 years (38–92); 44% patients were Caucasian, 6% White Hispanic, and 48% African American. Admissions by service were general medicine (37%), cardiology (31%), hematology/oncology (18%), and MICU (12%). Thirty-two patients (35%) were HE. HE patients had a greater median age (75 years vs 66 years; p < 0.005). Median length of stay was five days with no difference between HE and hospice ineligible (HI) patients; one outlier (385 days) was in the HE group. Other measures of resource utilization, such as ICU days, number of procedures, and radiology studies, did not differ between the two groups. There were nine deaths, with 5/27 (19%) rate in HE and 4/51 (8%) in the HI group. Median survival of the HE group was 381 days (2–2,195) and 2,030 days (2–2,160) for the HI group (p < 0.001). One year after admission, 16/32 (50%) of the HE group, and 15/59 (25%) of the HI group had died. Conclusion. At time of admission to a medical service, 35% of patients were HE. HE patients had an increased death rate and decreased survival. Current hospice criteria missed half of the patients who died within one year of admission. Implications for research, policy, or practice. Hospice criteria may identify candidates for palliative care on inpatient medical services. Further research is needed to develop case-finding criteria.

US survey finds higher availability of palliative care programs, palliative physicians and consultation teams and palliative outpatient services in National Cancer Institute centres compared to non-NCI centres

US survey finds higher availability of palliative care programs, palliative physicians and consultation teams and palliative outpatient services in National Cancer Institute centres compared to non-NCI centres

Impact of a Palliative Care Consultation Team on Cancer-Related Symptoms in Advanced Cancer Patients Referred to an Outpatient Supportive Care Clinic

Patients with advanced cancer may develop severe physical and psychosocial symptoms. There are limited data on the impact of an outpatient palliative consultation (PC) team on cancer-related symptoms. To study the impact of the PC on symptoms in patients with advanced cancer receiving outpatient palliative care. Four hundred six consecutive patients referred to a supportive care outpatient center (OPC) from January 2006 to June 2007 with complete Edmonton Symptom Assessment Scale (0-10 scale) at the initial and follow-up visits were reviewed. Patient characteristics, change of symptoms at follow-up visit, and response rate were analyzed. Using logistic regression models, the predictors of improvement of pain and fatigue were assessed. Median age was 59 years; 53% were female. Median interval between visits was 15 days. Mean scores at baseline and follow-up visits were fatigue 6.8 and 5.3 (P<0.0001), pain 5.3 and 4.1 (P<0.0001), depression 3.2 and 2.5 (P<0.0001), anxiety 3.7 and 2.8 (P<0.0001), dyspnea 2.7 and 2.5 (P=0.05), sleep 5 and 4 (P<0.0001), and well-being 5.2 and 4.4 (P<0.0001). Dyspnea (odds ratio and P-value, 0.90, 0.03), nausea (0.92, 0.06), and depression (0.91, 0.04) were associated with improvement in fatigue; drowsiness (1.10, 0.04), and feeling of well-being (0.87, 0.02) were associated with improvement in pain. The initial consult by PC achieved significant symptom improvement in patients receiving treatment in the OPC. Further prospective studies are needed.

Hospital-Based Palliative Care Consultation: Effects on Hospital Cost

Palliative care consultation teams in hospitals are becoming increasingly more common. Palliative care improves the quality of hospital care for patients with advanced disease. Less is known about its effects on hospital costs. To evaluate the relationship between palliative care consultation and hospital costs in patients with advanced disease. An observational study of 3321 veterans hospitalized with advanced disease between October 1, 2004 and September 30, 2006. The sample includes 606 (18%) veterans who received palliative care and 2715 (82%) who received usual hospital care. October 1, 2004 and September 30, 2006. We studied the costs and intensive care unit (ICU) use of palliative versus usual care for patients in five Veterans Affairs hospitals over a 2-year period. We used an instrumental variable approach to control for unmeasured characteristics that affect both treatment and outcome. The average daily total direct hospital costs were $464 a day lower for the 606 patients receiving palliative compared to the 2715 receiving usual care (p < 0.001). Palliative care patients were 43.7 percentage points less likely to be admitted to ICU during the hospitalization than usual care patients (p < 0.001). Palliative care for patients hospitalized with advanced disease results in lower costs of care and less utilization of intensive care compared to similar patients receiving usual care. Selection on unobserved characteristics plays an important role in the determination of costs of care.

Paediatric palliative home care by general paediatricians: a multimethod study on perceived barriers and incentives

BackgroundNon-specialist palliative care, as it is delivered by general practitioners, is a basic component of a comprehensive palliative care infrastructure for adult patients with progressive and far advanced disease. Currently palliative care for children and adolescents is recognized as a distinct entity of care, requiring networks of service providers across different settings, including paediatricians working in general practice. In Germany, the medical home care for children and adolescents is to a large extent delivered by general paediatricians working in their own practice. However, these are rarely confronted with children suffering from life-limiting diseases. The aim of this study was therefore to examine potential barriers, incentives, and the professional self-image of general paediatricians with regard to paediatric palliative care.MethodsBased on qualitative expert interviews, a questionnaire was designed and a survey among general paediatricians in their own practice (n = 293) was undertaken. The survey has been developed and performed in close cooperation with the regional professional association of paediatricians.ResultsThe results showed a high disposition on part of the paediatricians to engage in palliative care, and the majority of respondents regarded palliative care as part of their profile. Main barriers for the implementation were time restrictions (40.7%) and financial burden (31.6%), sole responsibility without team support (31.1%), as well as formal requirements such as forms and prescriptions (26.6%). Major facilitations were support by local specialist services such as home care nursing service (83.0%), access to a specialist paediatric palliative care consultation team (82.4%), as well as an option of exchange with colleagues (60.1%).ConclusionsAltogether, the high commitment to this survey reflects the relevance of the issue for paediatricians working in general practice. Education in basic palliative care competence and communication skills was seen as an important prerequisite for the engagement in paediatric palliative home care. A local network of specialist support on site and a 24/7 on-call service are necessary in order to facilitate the implementation of basic palliative care by paediatricians in their own practice.

Availability and integration of palliative care at US cancer centers.

The current state of palliative care in cancer centers is not known. To determine the availability and degree of integration of palliative care services and to compare between National Cancer Institute (NCI) and non-NCI cancer centers in the United States. A survey of 71 NCI-designated cancer centers and a random sample of 71 non-NCI cancer centers of both executives and palliative care clinical program leaders, where applicable, regarding their palliative care services between June and October 2009. Survey questions were generated after a comprehensive literature search, review of guidelines from the National Quality Forum, and discussions among 7 physicians with research interest in palliative oncology. Executives were also asked about their attitudes toward palliative care. Availability of palliative care services in the cancer center, defined as the presence of at least 1 palliative care physician. A total of 142 and 120 surveys were sent to executives and program leaders, with response rates of 71% and 82%, respectively. National Cancer Institute cancer centers were significantly more likely to have a palliative care program (50/51 [98%] vs 39/50 [78%]; P = .002), at least 1 palliative care physician (46/50 [92%] vs 28/38 [74%]; P = .04), an inpatient palliative care consultation team (47/51 [92%] vs 28/50 [56%]; P < .001), and an outpatient palliative care clinic (30/51 [59%] vs 11/50 [22%]; P < .001). Few centers had dedicated palliative care beds (23/101 [23%]) or an institution-operated hospice (37/101 [37%]). The median (interquartile range) reported durations from referral to death were 7 (4-16), 7 (5-10), and 90 (30-120) days for inpatient consultation teams, inpatient units, and outpatient clinics, respectively. Research programs, palliative care fellowships, and mandatory rotations for oncology fellows were uncommon. Executives were supportive of stronger integration and increasing palliative care resources. Most cancer centers reported a palliative care program, although the scope of services and the degree of integration varied widely.

Dying Tax Free: The Modern Advance Directive and Patients' Financial Values

Advance directives are often used to help patients articulate their end-of-life treatment preferences and guide proxy decision makers in making health care decisions when patients cannot. This case study and commentary puts forth a situation in which a palliative care consultation team encountered a patient with an advance directive that instructed her proxy decision maker to consider estate tax implications when making end-of-life decisions. Following presentation of the case, the authors focus on two ethical issues: 1) the appropriateness of considering patients' financial goals and values in medical decision making and 2) whether certain kinds of patient values should be considered more or less relevant than others as reasons for expressed treatment preferences. Clinicians are encouraged to accept a wide range of patient values as relevant to the clinical decision-making process and to balance the influence of those values with more traditional notions of clinical harm and benefit.

Multiple evaluation of a hospital-based palliative care consultation team in a university hospital: Activities, patient outcome, and referring staff's view

Although the number of hospital-based palliative care consultation teams (PCCTs) is rapidly increasing in Japan, there is limited information available concerning the activities and usefulness of PCCT in the country. The aim of this study is to clarify the activities, patient outcome, and referring staff's view of an established PCCT in Japan. This was a prospective study to follow patients referred to a PCCT for 28 days over a 1-year period. Patients were assessed by the Support Team Assessment Schedule-Japanese version (STAS-J) and EORTC QLQ C-30 at the time of referral and on days 7, 14, and 28. A staff survey was implemented using a questionnaire after each observation period. Of 180 patients referred, 53 patients were eligible for the study. Although the median of the number of the reasons for referral was 1, the PCCT provided several kinds of support: pain management, 94%; emotional support for the patient, 49%; and emotional support for the family, 36%. On day 7 after referral, of the items of STAS-J and the EORTC QLQ C-30 subscales, only insomnia improved significant whereas "other physical symptoms" and constipation were significantly exacerbated. In the staff survey, of the 98 respondents, more than 90% considered the effect of the PCCT as "excellent" or "good" and were satisfied with the support provided. This study showed that the PCCT performed comprehensive assessments on referred patients and provided extra support. No patient's QOL 1 week after referral was improved with the exception of insomnia. Referring staff highly evaluated the activities of the PCCT. In the evaluation of PCCTs, further research about the variation of clinical activities of PCCTs, their applicability, and benefit is needed.

Theory into Practice: Withdrawal of Artificial Life Support in the ICU (733)

1.Review concise medication order set for physicians to guide withdrawal of life support in ICU.2.Review ICU nurse's intervention and documentation form for withdrawal of life support in the ICU.3.Discuss the process of instituting a formalized program for withdrawal of life support in ICU. I. Background. This presentation portrays a three step process in providing quality end-of-life care in the ICU and summarizes the following interventions; integration into the ICU physician and nursing culture; construction and finalization of a physician medication order set and creation of a nursing intervention/documentation form. Theory was put into practice by an interdisciplinary team comprised of the Palliative Care Consult Team's (PCCT) nurse practitioner and physician, ICU nurse specialist and clinical application's pharmacist and nurse coordinator. We elected a minimalist approach in order to formalize a previously informal practice regarding withdrawal of life support in the ICU. There are many excellent clinical resources in the literature regarding withdrawal of life support in the ICU. We used them to form the foundation of the order set and nursing intervention/documentation form. However, forms alone are not sufficient to support a quality program. The PCCT immersed themselves within the medical and nursing culture of the ICU over a 2-year period using one on one interaction and role modeling. We view this period as the most influential aspect of this venture. II. Aims. Present medication order set and nursing intervention/documentation form to guide withdrawal of life support in the ICU. Discuss pathways the PCCT traveled in order to ensure viability of the medication order set and nursing intervention/documentation form. III. Method/Session Description. Poster/Presentation. IV. Conclusion. Formalization of a medication order set and nursing intervention/documentation form will enable all care providers to facilitate a peaceful death for patients who undergo withdrawal of life support. The forms also foster medical and nursing staff to include social work, chaplains, and the patient's family in all aspects of the withdrawal of care process.

Nursing Evaluation of Palliative Resources in an Acute Care Setting: Perceptions, Satisfaction, and Educational Needs (718)

Background: There is a lack of research available evaluating nursing staff perceptions of palliative care services and the educational needs derived from those perceptions. Purpose: To determine baseline nursing satisfaction scores and educational needs related to the palliative care resources currently available at the University of Kansas Hospital. Methods: Of approximately 1500 nurses, 216 completed the survey (15%). The survey was developed by a palliative care nurse and reviewed by the medical director. The survey included 18 quantitative and qualitative questions in five major categories: perceptions of palliative care, nursing attitudes when caring for patients receiving palliative care services, symptom management, nursing satisfaction, and education. Findings: While 85.8% of nurses surveyed realize palliative care is not only for end of life, only 65% were comfortable caring for patients who were still actively receiving treatments. When caring for patients, nurses report feeling fulfilled (45%) and sad (43%). Dyspnea was reported to be the most challenging symptom to manage (52.9%), followed by anxiety (39%) and pain (37%). Participants felt the presence of the palliative care consult team contributed to improved nursing care (80%) and job satisfaction (70%). Educational needs identified by the nurses included a palliative care reference manual (79.5%) and a 4 hour CEU offering (47.8%). Conclusion: Findings show that nurses’ report knowing what palliative care is and yet fewer felt comfortable caring for palliative care patients who were not on pure comfort measures. Nurses identified a need for improved communication from the palliative care team as well as education addressing caring for palliative care patients earlier in the disease trajectory. Future Considerations: Implementation of the suggested educational methods and a follow-up survey will be needed to evaluate the effectiveness of the interventions on the five major categories.

Pain Management in Advanced Illness and Comorbid Substance Use Disorder

Pain is a common, feared, and often undertreated symptom faced by people with life-limiting illnesses. Those with substance use disorder are at an even greater risk of inadequate pain management. Much of the literature addresses those with chronic nonmalignant pain, with limited literature focusing on those with advanced illness, pain, and comorbid addictive disease. The purpose of this article was to provide assessment and treatment strategies for safe pain management in this population. This article highlights a case study of a patient with advanced illness, pain, and comorbid substance use disorder who was seen by the palliative care consultation team in the home care setting.

The last days of dying stroke patients referred to a palliative care consult team in an acute hospital

Needs of patients dying from stroke are poorly investigated. We aim to assess symptoms of these patients referred to a palliative care consult team, and to review their treatment strategies. All charts of patients dying from stroke in a tertiary hospital, and referred consecutively to a palliative care consultant team from 2000 to 2005, were reviewed retrospectively. Symptoms, ability to communicate, treatments, circumstances and causes of death were collected. Forty-two patients were identified. Median NIH Stroke Scale on admission was 21. The most prevalent symptoms were dyspnoea (81%), and pain (69%). Difficulties or inability to communicate because of aphasia or altered level of consciousness were present in 93% of patients. Pharmacological respiratory treatments consisted of anti-muscarinic drugs (52%), and opioids (33%). Pain was mainly treated by opioids (69%). During the last 48 h of life, 81% of patients were free of pain and 48% of respiratory distress. The main causes of death were neurological complications in 38% of patients, multiple medical complications in 36%, and specific medical causes in 26%. Patients dying from stroke and referred to a palliative care consult team have multiple symptoms, mainly dyspnoea and pain. Studies are warranted to develop specific symptoms assessment tools in non-verbal stroke patients, to accurately assess patients' needs, and to measure effectiveness of palliative treatments.

Physician and Nurse Perceptions of a New Inpatient Palliative Care Consultation Project: Implications for Education and Training

Few studies have examined ease of integrating palliative care programs into hospital culture. The purpose of this article is to report findings from focus groups conducted among physicians and nurses to elicit their perceptions of an inpatient palliative care team consultation service after 1 year of operation. The study consisted of four homogeneous focus groups drawn from a purposive sample of physicians (2 groups; total n = 16) and nurses (2 groups; n = 17) at a large urban managed care center. Structured interview protocols were used to elicit participant perceptions regarding the impact of implementation. Focus groups were audiotaped and transcribed verbatim. We analyzed the data using grounded theory techniques to elicit themes and subthemes. Five major themes emerged regarding the positive and/or transformational impact of the program on patient/family services, medical staff, the hospital, quality of care, and time. Physician and staff observations regarding perceived barriers to integration included subthemes pertaining to the sharing of information, patient/family resistance and cultural differences, and the need for increased services. The vast majority of comments expressed were related to positive aspects of the program. However, barriers exist that prevent some terminally ill patients from receiving these services. Findings from this study have implications for the need for education and training among providers on palliative and hospice services and, in particular, on the benefits of an inpatient palliative care team for patients, regardless of their attitudes toward end-of-life care programs.

Development of a Standard for Hospital-Based Palliative Care Consultation Teams Using a Modified Delphi Method

Although palliative care consultation teams are rapidly being disseminated throughout Japan as a result of government policy, the role of these teams has not been standardized. The aim of this study was to develop a hospital-based palliative care consultation team standard. We adopted a modified Delphi method to develop a standard. Twenty-seven multiprofessional panelists were selected according to two criteria: adequate experience as part of a palliative care consultation team and representative of 16 palliative care-related organizations. Panelists rated the appropriateness of 33 statements in a provisional standard, which was generated by the authors, using a nine-point Likert-type scale in a first-round survey. We set two criteria for agreement: the median value was 8 or more, and the difference between the minimum and maximum was 4 or less. There were 15 disagreements in the first-round survey. Based on discussions through e-mails and a panel meeting, these 15 statements were dealt with as follows: one was rejected, one was combined with another statement, three were unmodified, and 10 underwent minor revisions. Moreover, two statements that generated agreement were divided into two statements each. Consequently, the number of statements was 37. In a second-round survey, three statements engendered disagreement and were modified. At the end of the process, there were 37 statements in four areas: “philosophy and policy,” “structure for care provision,” “contents of activities,” and “quality assurance and care improvements.” This standard may be useful as a clinical activity guide as well as a method to evaluate palliative care consultation teams.

Referrals of Cancer versus Non-Cancer Patients to A Palliative Care Consult Team: Do They Differ?

This retrospective study compared 100 consecutive non-cancer (NC) patients referred to a palliative care consult team (PCT) in a Swiss university hospital to 506 cancer (C) patients referred during the same period. The frequencies of reported symptoms were similar in both groups. The main reasons for referral in the NC group were symptom control, global evaluation, and assistance with discharge. Requests for symptom control predominated in the C group. Prior to the first visit, 50% of NC patients were on opioids, compared to 58% of C patients. After the first visit, the proportion of NC patients on opioids increased to 64% and the proportion of C patients to 73%. The median daily oral morphine equivalent dose for NC patients taking opioids prior to the first PCT visit was higher than that for C patients (60 mg versus 45 mg). At the time of death or discharge, the percentage of NC patients on opioids was 64%, while that of C patients was 76%. Moreover, NC patients were on significantly lower median doses of opioids than C patients (31 mg versus 60 mg). Over half the NC patients died during hospitalization, as compared to 33% of C patients. Only 6% of NC patients were discharged to palliative care units, as compared to 22% of C patients.

Use of the Palliative Performance Scale (PPS) for End-of-Life Prognostication in a Palliative Medicine Consultation Service

This study examines the use of the Palliative Performance Scale (PPS) in end-of-life prognostication within a regional palliative care program in a Canadian province. The analysis was done on a prospective cohort of 513 patients assessed by a palliative care consult team as part of an initial community/hospital-based consult. The variables used were initial PPS score, age, gender, diagnosis, cancer type, and survival time. The findings revealed initial PPS to be a significant predictor of survival, along with age, diagnosis, cancer type and site, but not gender. The survival curves were distinct for PPS 10%, 20%, and 30% individually, and for 40%–60% and ≥70% as bands. This is consistent with earlier findings of the ambiguity and difficulty when assessing patients at higher PPS levels because of the subjective nature of the tool. We advocate the use of median survival and survival rates based on a local cohort where feasible, when reporting individual survival estimates.

Impact of a new palliative care consultation team on opioid prescription in a University Hospital.

BackgroundThere are no validated measuring tools to gauge the effectiveness of a Hospital Palliative Care Consultation Team (PCCT). One way would be to consider its effect on the consumption of opioids expressed in total amounts and different formulations administered. We perform this study to evaluate the impact of a hospital PCCT on the trends of opioid prescription in a University Hospital.MethodsA seven year retrospective study on opioid prescription was carried out in the Clínica Universidad de Navarra. The period includes three years before and three years after the PCCT was implemented. Prescription was analysed calculating yearly the Defined Daily Dose (DDD) adjusted to 1000 hospital stays (DDD/1000HS). Indicators considered were the proportion of patients treated using opioids compared to the total estimated in need of treatment (rate of effectiveness) and the proportion of patients potentially requiring opioids but not treated who were incorporated into the treatment group (rate of improvement).ResultsFrom 2001 to 2007, total opioid prescription was low in non-oncology Departments (range: 69–110 DDD/1000HS) while parenteral morphine and fentanyl did not register any changes. In the same period of time, total opioid prescription increased in the Oncology Department from 240 to 558 DDD/1000HS. The rate of effectiveness in the three years prior to the implantation of the consultation team was 64% and in the three following years rose to 87%. The rate of improvement prior to the palliative care consultation team was 43% and in the three following years was 64%. A change in opioid prescription was registered after the implementation of the PCCT resulting in an increase in the prescription of parenteral morphine and methadone and a decrease in transdermal fentanyl.ConclusionImplementation of a PCCT in a University Hospital is associated with a higher and more adequate use of opioids.

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

The symptom burden of intensive care unit (ICU) patients who are referred to a palliative care team (PCT) has not been characterized to the authors' knowledge, and the response of these symptoms to the palliative care intervention has not been reported. The authors retrospectively reviewed PCT consults for ICU patients who were seen between July 2006 and October 2007. To characterize symptom distress and outcomes in ICU patients who were referred to PCT in a cancer center, information and descriptive statistics about patients' demographics, comorbidities, PCT findings, interventions, and outcomes were obtained. The chi-square test was used to analyze ICU and PCT mortality, and the signed-rank test was used to analyze PCT interventions. Of 1637 PCT consults, 88 consults (5%) were from the ICU. The median patient age was 60 years (range, 22-87 years), and 41 patients (46%) were women. The types of cancers were hematologic (19 patients; 22%), gastrointestinal (19 patients; 22%), lung (18 patients; 20%), and others (24 patients; 26%). Nineteen patients were on mechanical ventilation (MV), and 24 patients were on bilevel positive airway pressure (BIPAP). The findings were delirium (71 patients; 81%), dyspnea (67 patients; 76%), pain (74 patients; 84%), fatigue (84 patients; 95%), and anxiety (57 patients; 65%). The interventions used were opioid management (99%), steroids (70%), antipsychotics (76%), and counseling (100%), do not resuscitate conversion (62 of 88 patients; 70%), withdrawal of MV (15 of 19 patients; 79%), and withdrawal of BIPAP (26 of 26 patients; 100%). Improvement was reported in pain (67 patients; 90%), dyspnea (60 patients; 90%), anxiety (51 patients; 80%), and delirium (31 patients; 44%). Thirty-five patients (40%) were transferred to the palliative care unit (PCU). Fifty-one ICU/PCT patients (58%) died during admission versus 130 of 1549 (8%) non-ICU PCT patients (P<.0001). Twenty-three of 35 patients who were transferred to the PCU (66%) died there versus 212 of 629 patients (34%) who were admitted to the PCU from another service (P<.0001). Thirty-seven of 88 ICU/PCT patients (42%) were discharged alive. ICU patients who are referred to the PCT have severe symptom distress. The PCT was able to identify multiple problems and make numerous pharmacologic and nonpharmacologic recommendations that improved these symptoms, including the participation in do not resuscitate conversion and withdrawal of MV and BIPAP. Although many patients in this population died, a significant subset, including those who were transferred to the PCU, survived to discharge.