The long term objective of this research training grant is to prepare the applicant as a nurse scientist in aging and palliative care research. The goal of the fellowship is to obtain competency in qualitative research methods, data collection and analysis, and dissemination of findings. Public opinion research about palliative care reveals that 62% of US healthcare consumers over 65 years of age want access to palliative care if they have a serious illness. Eighty-five percent of residents in nursing homes are over the age of 65. Despite being promoted as an effective method to deliver high quality care to nursing home residents with serious life limiting illness, palliative care is not widely available. This could rsult in unintended emphasis on aggressive rehabilitation over palliative goal oriented care, little acknowledgement of patient's values and preferences for palliative care, and missed opportunities for symptom management including psychosocial and spiritual support. There is limited research that follows patients after a hospital-based palliative care consult and subsequent discharge to a nursing home without hospice support. This research will improve understanding of factors and conditions of care delivery in nursing homes after receiving a palliative care consult during hospitalization and measure patient perceptions of care.
The specific aims of this qualitative descriptive study are to:
Aim 1) Describe the continuity of patients palliative care plan from the hospital to the nursing home, and Aim 2) Describe the experience of patients admitted to the nursing home following discharge from a hospital with a palliative care consult. Up to thirty participants will be recruited from an inpatient hospital palliative care program with discharge planned to one of two nursing homes for post-hospital care without hospice support. Semi-structured interviews, and chart reviews will be conducted. Iterative data coding and analysis will identify categories and themes to develop a rich description of the experience and outcomes of patients admitted to the nursing home after discharge from a hospital with a palliative care consult. In congruence with the National Institute of Nursing Research, this project seeks improve understanding of outcomes for individuals with serious life limiting illness across care settings and positively impact the quality of life for peple living with serious complex life-limiting illness in nursing homes.
Palliative care clinical practice guidelines and accrediting agencies emphasize the need for palliative care in nursing homes and coordination between care settings for optimal palliative care delivery, in particular, between the hospital and nursing home. The immediate and long-term outcomes of transition and nursing home care is unclear for patients who receive hospital palliative care consults and are discharged to a nursing home without hospice. This research will describe the experience of residents in the nursing home after palliative care consult during hospitalization.
