Benefits and Barriers of Palliative Care in Nursing Homes: A Qualitative Descriptive Study

Outcomes 1. Enhance the learner's knowledge of palliative care benefits for nursing home residents.2. Enhance the learner's knowledge of barriers to palliative care for nursing home residents. Key Message This qualitative descriptive study records the perspective of clinicians involved in the care of nursing home residents. Participants describe the benefits and barriers of palliative care at the resident and facility level. The results provide targets for future interventions aimed at improving access to palliative care for nursing home residents. Introduction Palliative care can improve comfort, quality of life, and patient/family care experiences while decreasing cost. Despite these positive outcomes, nursing home residents do not receive palliative care services relative to the high prevalence of perceived need. Objective To identify and describe the benefits and barriers of palliative care in nursing homes from the perspective of nursing home staff, primary care practitioners, and specialty palliative care providers. Methods We applied a rapid qualitative approach to analyze semi-structured interviews using directed content analysis. Participants were eligible if they worked in the nursing home setting or provided palliative care to nursing home residents. Results Participants (N=17) included nursing home key informants representing a variety of roles (e.g., nurses, physician, nurse practitioners). Participant perceptions of benefits and barriers are organized at the resident and facility level.Benefits. Resident-level: 1) improved symptom management; and 2) extra support and services [subthemes: spiritual care, bereavement, transparent discussions and anticipatory guidance]. Facility-level: 3) legal and regulatory compliance [subthemes of opioid prescribing, behavior management, and nursing home regulations]; and 4) extra medical support [subtheme of preventing hospitalization].Barriers. Resident-level: 1) misperceptions of palliative care [subtheme of stigma]; 2) transportation difficulties; 3) conflicted goals of care [subthemes of rehabilitation, complex family dynamics, and lack of anticipatory guidance]; and 4) financial disincentives. Facility-level: 5) financial disincentives; 6) workforce limitations; and 7) lack of referral standards. Conclusions Our findings describe perceived benefits and barriers of palliative care in nursing homes from the perspective of key informants. For nursing home administrators and policymakers, the identified barriers can inform the development of targeted training programs and resources for staff to address these challenges effectively. Moreover, recognizing the benefits can emphasize the value of investing in palliative care services and encourage the integration of such programs into the standard care provided. Keywords Scientific Research / Models of Palliative Care Delivery