Trigger-Based Referral and Needs Assessment in the Intensive Care Unit: A Narrative Review and Conceptual Synthesis

Abstract

Highlights What are the main findings? Trigger-based referral criteria provide a practical way to identify clinical vulnerability, but their relationship with directly measured multidimensional palliative care need remains uncertain. One multicenter study found limited discrimination of serious unmet need by conventional trigger status; replication is required across populations, instruments, and healthcare systems. What are the implications of the main findings? Trigger criteria should remain available as one route to further assessment rather than being treated as validated measures of need or automatic mandates for specialist referral. Prospective studies should compare trigger-only, needs-assessment, integrated, and usual-care strategies before any combined approach is adopted. Abstract Background/Objectives: Trigger-based referral systems are widely used to identify intensive care unit (ICU) patients who may benefit from palliative care, but the extent to which trigger status corresponds to multidimensional patient and family need remains uncertain. This narrative review examines trigger-based referral, needs assessment, and integrated approaches to ICU palliative care. Methods: PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and reference lists were searched, and a purposive thematic synthesis was conducted. The original identification-stage record counts were unavailable; selection was reconstructed from an archived full-text library, and screening was primarily performed by one author. Results: Trigger-based systems improved recognition of clinically vulnerable patients and several care processes. Direct evidence comparing trigger status with measured need is limited, however, and derives principally from one multicenter study using a family-member-reported NEST score. The literature supports distinguishing clinical risk from measured need but does not establish the superiority of trigger-based, needs-based, or integrated models. Conclusions: Current evidence supports comparative testing rather than adoption of any integrated configuration. Candidate components, timing, thresholds, feasibility, and applicability across healthcare systems require prospective evaluation.