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.
Joan G. Carpenter, PhD, CRNP, ACHPN, is postdoctoral nurse research fellow, Patient Care Services/Department of Nursing, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Patricia H. Berry, PhD, RN, ACHPN, FPCN, FAAN, is director, Hartford Center of Gerontological Nursing Excellence at Oregon Health and Science University, and professor, Oregon Health and Science University School of Nursing, Portland.
Mary Ersek, PhD, RN, FPCN, is senior scientist, Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center; and Killebrew-Censits Chair in Undergraduate Education and professor of palliative care, University of Pennsylvania School of Nursing, Philadelphia.
Address correspondence to Joan G. Carpenter, PhD, CRNP, ACHPN, Patient Care Services/Department of Nursing, Corporal Michael J. Crescenz VAMC, 3900 Woodland Ave, Bldg 4100, Philadelphia, PA 19104 (Joan.Carpenter@va.gov).
J.G.C. was a 2011-2013 Archbold Scholar supported by the John A. Hartford Foundation's National Hartford Centers of Gerontological Nursing Excellence Award Program. This work was supported by the National Institute of Nursing Research of the National Institutes of Health under award numbers T32NR013456 and F31NR014608. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. No competing financial interests exist. The funding organization had no role in the design and conduct of the study or in the preparation, review, or approval of the manuscript.
The authors have no conflicts of interest to disclose.