The Prevalence of Inpatients at 33 U.S. Hospitals Appropriate for and Receiving Referral to Palliative Care

Marilyn K. Szekendi, Jocelyn Vaughn, Ashima Lal, Kei Ouchi, Mark V. Williams

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Background: The extent of unmet need for palliative care in U.S. hospitals remains largely unknown. We conducted a multisite cross-sectional, retrospective point prevalence analysis to determine the size and characteristics of the population of inpatients at 33 U.S. hospitals who were appropriate for palliative care referral, as well as the percentage of these patients who were referred for and/or received palliative care services. We also conducted a qualitative assessment of barriers and facilitators to referral, focusing on organizational characteristics that might influence palliative care referral practices. Methods: Patients appropriate for palliative care referral were defined as adult (≥18 years) patients with any diagnosis of a poor-prognosis cancer, New York Heart Association class IV congestive heart failure, or oxygen-dependent chronic obstructive pulmonary disease who had inpatient status in 1 of 33 hospitals on May 13, 2014. Qualitative assessment involved interviews of palliative care team members and nonpalliative care frontline providers. Results: Nearly 19% of inpatients on the point prevalence day were deemed appropriate for palliative care referral. Of these, approximately 39% received a palliative care referral or services. Delivery of palliative care services to these patients varied widely among participating hospitals, ranging from approximately 12% to more than 90%. Factors influencing differences in referral practices included nonstandardized perceptions of referral criteria and variation in palliative care service structures. Conclusion: This study provides useful information to guide providers, administrators, researchers, and policy experts in planning for optimal provision of palliative care services to those in need.

Original languageEnglish
Pages (from-to)360-372
Number of pages13
JournalJournal of Palliative Medicine
Issue number4
StatePublished - Apr 1 2016

Bibliographical note

Publisher Copyright:
© Copyright 2016, Mary Ann Liebert, Inc. 2016.

ASJC Scopus subject areas

  • General Nursing
  • Anesthesiology and Pain Medicine


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