Identifying Palliative Care Consultation Outcomes in Nursing Homes: Insights from Key Partners

Palliative care (PC) consultation outcomes in nursing homes (NHs) are often assessed using health systems' clinical and utilization metrics rather than outcomes from the perspective of the key partners who provide and sustain it. This study was designed to identify meaningful PC consultation outcomes from the perspectives of NH staff, PC consultants, and NH/PC agency directors.

Using a qualitative descriptive approach, the team conducted semi-structured interviews with key partners from 14 NHs in the Eastern United States. Interviews were transcribed and analyzed using conventional content analysis.

Participants (N = 33) included NH staff (e.g., primary care providers and nurses), PC consultants (e.g., PC physicians and PC nurse practitioners), and leaders (e.g., NH directors and PC agency directors). Key partners reported meaningful outcomes in four domains: resident, family, NH staff, and NH facility. Resident outcomes included goal-concordant care, symptom management, hospitalization rates, and understanding of care choices and control. Family outcomes included shared decision-making, understanding of the resident's disease trajectory and management measures, and feeling supported. NH staff outcomes included capacity to provide high-quality care and emotional support. Lastly, NH facility outcomes included filling care gaps, facility reputation, and organizational morale.

These findings highlight multi-domain and interdependent PC consultation outcomes across residents, families, staff, and NH facilities that may be overlooked in existing evaluation frameworks. Future interventions and quality measures should incorporate these outcomes and ensure that residents' and families' perspectives are represented.