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Barriers to perioperative palliative care across Veterans Health Administration hospitals: A qualitative evaluation
Emily E Evans1, Sarah E Bradley2, C Ann Vitous3
1University of Michigan Medical School, Ann Arbor, MI, USA.
Background:
Palliative care remains widely underused for surgical patients, despite a clear benefit for patients with life-limiting illness or nearing the end-of-life.
Methods:
Interviews exploring end-of-life care among critically-ill surgical patients were conducted with providers from 14 pre-specified Veterans Affairs (VA) hospitals. Data were analyzed iteratively through steps informed by inductive and deductive descriptive content analysis.
Results:
Six major domains were identified. At the patient and family level, barriers included managing expectations and goal-discordant care. At the provider-level, knowledge of and attitudes towards palliative care and provider role and identity were frequently cited barriers. At the system-level, participants identified institutional resources and culture as significant barriers.
Conclusions:
While providers recognize the importance of palliative care and end-of-life care, obstacles to its use exist at various levels. Identification of these barriers highlights areas to focus future efforts to improve the quality of palliative and end-of-life care for Veterans.
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