To assess perspectives of US community-based palliative care program leaders on staffing, recruitment, and training, a qualitative descriptive study was conducted. Leaders (n = 20) from academic medical centers, large integrated and community health systems, home health and hospice organizations, and the Veterans Administration were recruited. Three major categories emerged that influence community-based palliative care workforce team composition across settings: (1) staffing models and recruitment are influenced by setting and workforce experience, (2) training varies by setting, and (3) demand exceeds supply of trained workforce. Participants described a hybrid approach used in academic and community settings to complete an interdisciplinary team by leveraging social work and chaplaincy from inpatient departments and home health and hospice. Physician-led interdisciplinary teams in academic settings and teams more often led by nurse practitioners in community settings were reported. Community program leaders expressed the desire to recruit nurses with home health and hospice experience because of the ability to work independently. Training was described as more often on-the-job in community settings. Turnover related to the lack of a properly trained workforce was described as one of the biggest barriers to palliative care development.
Nancy Dudley, PhD, RN, is Veterans Affairs quality scholar, San Francisco Veterans Affairs Medical Center, Geriatrics, Palliative & Extended Care; and Assistant Adjunct Professor, Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco.
Susan Chapman, PhD, RN, is professor, Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco.
Joanne Spetz, PhD, is professor, Institute for Health Policy Studies, Department of Family and Community Medicine, and School of Nursing, University of California, San Francisco.
Address correspondence to Nancy Dudley, PhD, RN, San Francisco Veterans Affairs Medical Center, 4150 Clement St (181G), San Francisco, CA 94121 (Nancy.Dudley@ucsf.edu).
The authors have no conflicts of interest to disclose.