Abstract
Despite hospital palliative care consultations during which goals of care are discussed in the context of poor prognoses, older adults are admitted to nursing homes (NHs) for post-acute care where the focus is on rehabilitation. The purpose of this qualitative descriptive study was to describe factors that influence discontinuity between a palliative care consult and NH care and explore the potential consequences of this discontinuity. Twelve adults (mean age, 80 years) were enrolled from 1 community hospital and NH in the mid-Atlantic United States. Semistructured interviews and medical record reviews were used to elicit information about clinical course, care processes, and patient/family preferences at hospital discharge and up to 4 times after NH admission. Data were analyzed using inductive content analysis techniques. Analysis revealed 2 themes: inadequate communication, characterized by the lack of information about the palliative care consult after hospital discharge, and prognosis incongruence, evidenced by data demonstrating a discrepancy between hospital prognosis and NH care. Ongoing communication between settings to readdress goals of care, prognosis, and symptoms - the central tenets of palliative care - is lacking. Efforts to improve access to comprehensive palliative care delivery after hospitalization and during NH transitions are greatly needed.
Original language | English (US) |
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Pages (from-to) | 153-159 |
Number of pages | 7 |
Journal | Journal of Hospice and Palliative Nursing |
Volume | 20 |
Issue number | 2 |
DOIs | |
State | Published - Apr 1 2018 |
Keywords
- continuity of patient care
- hospitalization
- nursing homes
- palliative care
- post-acute care
ASJC Scopus subject areas
- Community and Home Care
- Advanced and Specialized Nursing