Nursing Home Palliative Care Referral Process: A Qualitative Study (GP136)

Outcomes 1. Enhance the learner's knowledge of the nursing home palliative care referral process.2. Enhance the learner's knowledge of palliative care referral barriers and recommended solutions as perceived by nursing home staff and providers. Key Message This qualitative descriptive study examines the perspective of clinicians involved in the care of nursing home residents. Participants describe the palliative care referral process and important barriers along the referral pathway with actionable recommendations. Importance 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 consultation services relative to the high prevalence of perceived need. Objective(s) To examine the nursing home palliative care referral process and describe the barriers and solutions to consultation as perceived by nursing home staff, 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. Overall, each group described the various processes of referring residents for palliative care consultation in nursing homes and common barriers. The referral process was described as a complex multistep process comprising several distinct stages that were common among all participants. The stages [and barriers] encompass: 1) resident identification [lack of referral standards, lack staff knowledge, staff focus on tasks such as medication administration] 2) eligibility assessment [financial disincentive], 3) consensus-building [misperceptions, conflicted goals of care], and 4) consultation [transportation, workforce limitations]. In addition, many participants spontaneously provided recommendations for ways to improve the referral process and mitigate these barriers. Conclusion(s) Our findings describe the nursing home palliative care referral process including the barriers and solutions as perceived by nursing home staff, providers, and palliative care specialists. 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. Impact The results highlight the complex multistep palliative care referral process and provide targets for future interventions aimed at improving access to palliative care for nursing home residents.