Nursing Home Resident Palliative Care Referral Criteria: A Qualitative Descriptive Study (GP137)

Outcomes 1. Enhance the learner's knowledge of palliative care referral criteria for nursing home residents.2. Describe priority criteria for palliative care specialist consultation for nursing home residents. Key Message NH residents experience a multitude of unmet palliative care needs. This qualitative descriptive study records the perspective of key individuals involved in the care of nursing home residents. Participants describe important screening and referral criteria along with perspectives on prioritization criteria for palliative care resources in nursing homes. Importance Nursing home residents do not receive palliative care services in relation to their high prevalence of serious illness. One critical barrier to high quality palliative care in the nursing home setting is the lack of consistent and standardized screening and referral criteria. Objective(s) To explore, identify, and describe potential nursing home resident palliative care referral criteria from the perspective of nursing home staff, nursing home providers, and palliative care specialists. Scientific Methods Utilized 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 Seventeen participants representing various roles (e.g., nurses, physician, nurse practitioners) participated. Our analysis identified five domains related to potential nursing home resident palliative care referral criteria: 1) uncontrolled symptoms, 2) serious illness, 3) global indicators of decline 4) support needs, and 5) transition to hospice. Overall, there was consensus among our participants regarding the importance of these domains and the prioritization of patients with uncontrolled symptoms, specifically those experiencing pain, dyspnea, and behavioral manifestations of dementia. Additionally, the number of factors identified within these five domains was extensive and diverse. Conclusion(s) The complex array of criteria uncovered in this study highlights the intricate decision-making process surrounding palliative care referrals in nursing homes. It emphasizes the pressing need for enhanced clarity and standardized guidelines. Impact By understanding the diverse domains and factors influencing palliative care referrals, we can work towards establishing evidence-based criteria. Further research is imperative to discern the optimal method for integrating these domains into a standardized process for identifying nursing home residents who would benefit from palliative care, ultimately improving the overall care provided to nursing home residents with serious illness.