The meaning of comfort measures only order sets for hospital-based palliative care providers

Abstract

Purpose Comfort Measures Only (CMO) is a label commonly used in the USA that guides the care of a hospitalized patient who is likely to die. The CMO label has unclear and inconsistent meaning, calling to question the experiences and practices of hospital-basedalliative care providers. The purpose of this study was to understand the meaning of CMO as experienced by hospital-based palliative care providers. Methods Using hermeneutic phenomenological research, we investigated eight palliative care experts’ common experiences and shared practices of using CMO order sets in their hospital work settings. Data were collected through individual face-to-face interviews, and were analysed by an interpretive team. Results Four related themes and one constitutive pattern of “Dealing with Dying” reflect the meaning of comfort-measures-only practices. The themes are: comfort care as morphine drip; enacting a traditional binary pattern of care: all or nothing; supporting patient and family at end of life vs. CMO; and evolving culture—a better way to care for the dying. Conclusion Palliative care providers and non-palliative clinicians understood and practiced end of life care in sharply different ways with dying in hospital settings, raising new questions that analyse, modify and extend extant knowledge.

Keywords

• phenomenology
• hermeneutics
• dying
• palliative care
• terminal care
• end of life