LAUSR

To the Editor: Palliative medicine consult teams (PMCTs) support patients with life-limiting illness, their families and consulting clinicians by providing recommendations about symptom management and goals of care. These recommendations, in turn, may improve patients’ quality of life and symptom burden. Although there is a large body of work describing the demographic and symptom profiles of patients seen by palliative medicine teams, there are few studies describing the rate of implementation of recommendations. For example, Manfredi et al. demonstrated that palliative medicine teams recommended an average of 4.2 recommendations per patient and 91% were implemented by the consulting team. Chong et al. demonstrated similar findings; 2.84 recommendations were made per patient and 84% were implemented. Rabow et al., however, described low implementation rates, reporting that ‘‘few’’ patients received recommended analgesic or antidepressant medications. More recent work revealed similar results; only 57% of palliative medicine team recommendations were implemented. This work described whether PMCT interventions were implementeddyes or no. Physicians, however, rarely make yes/no clinical decisions based primarily on verbatim recommendations; decisions are often largely made based on experience, culture, and emotion. This phenomenon maybe particularly prevalent in end-of-life care where the strong emotions generated by caring for those with life-limiting illness can impact how physicians interpret and implement recommendation. As such, PMCT recommendations, rather than being implemented verbatim or not implemented, may be modified by the requesting clinician(s). We, therefore, wanted to expand on prior work by exploring where recommendations made by