Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff
Open accessAbstract
Background: Early introduction of palliative care can improve patient-centered outcomes for older adults with complex medical conditions. However, identifying the need for and introducing palliative care with patients and caregivers is often difficult. We aim to identify how and why a multi-setting approach to palliative care discussions may improve the identification of palliative care needs and how to facilitate these conversations. Methods: Descriptive qualitative study to inform the development and future pilot testing of a model to improve recognition of, and support for, unmet palliative care needs in home health care (HHC). Thematic analysis of semi-structured interviews with providers across inpatient (n = 11), primary care (n = 17), and HHC settings (n = 10). Results: Four key themes emerged: 1) providers across settings can identify palliative care needs using their unique perspectives of the patient’s care, 2) identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers, 3) importance of identifying a clinical lead of patient care who will direct palliative care discussions (primary care provider), and 4) importance of identifying a care coordination lead (HHC) to bridge communication among multi-setting providers. These themes highlight a multi-setting approach that would improve the frequency and quality of palliative care discussions. Conclusions: A lack of structured communication across settings is a major barrier to introducing and providing palliative care. A novel model that improves communication and coordination of palliative care across HHC, inpatient and primary care providers may facilitate identifying and addressing palliative care needs in medically complex older adults.
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Support for family caregivers during the transition period is relatively scarce.
“Recent studies have shown that support for family caregivers during the transition period is relatively scarce [19].”
From Experiences of family caregivers of patients with end-of-life cancer during the transition from hospital to home palliative care: a qualitative study (2024) · cites this paper as [19]
The Introduction (page not provided) says few studies have identified ways to address unmet palliative-care needs among older home-health-care patients and their family caregivers. The section on identifying palliative-care needs reports that poor communication makes patient and caregiver needs difficult to detect across settings. Neither passage establishes that support actually available to family caregivers during transitions is relatively scarce. (LLM, conf=0.82)
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- Authors
- Tietbohl, C. K., Dafoe, A., Jordan, S. R., Huebschmann, A. G., Lum, H. D., Bowles, K. H., & Jones, C. D.
- Affiliations
- Children's Hospital Colorado (US)
- University of Colorado Anschutz (US)
- VNS Health (US)
- Veterans Health Administration (US)
- Corresponding author
- Tietbohl, Caroline K.
- ORCID
- Venue
- American Journal of Hospice and Palliative Medicine®
- Publisher
- SAGE Publications
- Published
- 2023-03-12
- Volume
- 40
- Issue
- 12
- Pages
- 1371-1378
- ISSN
- 1049-9091 (ISSN-L)
- 1938-2715
- PMC
- PMC10495535
- OpenAlex
- W4324018448
- Cited by
- 9
- References
- 30
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 1 · 2023: 1
- FWCI
- 2.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Hospice and Palliative Medicine® (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R21AG067038)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- palliative care, home health care, inpatient care, primary care, interprofessional communication, care coordination, older adults, medically complex patients, barriers to palliative care
- MeSH terms
- Aged, Patient Care, Humans, Inpatients, Palliative Care, Primary Health Care, Caregivers, Qualitative Research
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