title: Obstacles to palliation and end-of-life care in a long-term care facility.
abstract: OBJECTIVE
  This exploratory study used a set of four obstacle constructs derived from both the existing literature and our earlier work to describe the diverse end-of-life scenarios observed for a group of residents in a long-term care facility.
  
  
  METHODS
  Data from a retrospective chart review and both quantitative and qualitative methods of data collection and analysis were used to examine in-depth the end-of-life experiences of all nursing home residents (N = 41) who died on the nursing care unit of a large continuing care retirement community during an 18-month period.
  
  
  RESULTS
  A hierarchy of obstacles to palliation and end-of-life care seems to exist in long-term care settings that begins with the lack of recognition that restorative, rehabilitative, or curative treatment futility has commenced. The next three obstacles in sequence include lack of communication among decision makers, no agreement on a course of care, and failure to implement a timely plan of care.
  
  
  CONCLUSIONS
  The findings highlight the importance of determining treatment futility as an initial step in the successful delivery of palliative and end-of-life care to residents in long-term care followed by the need for a deliberate and proactive series of actions and care planning processes.
authors.affiliation: College of Nursing and Health Professions, University of North Carolina at Charlotte, 28223-0001, USA. sstravis@email.uncc.edu
authors.forename: Shirley S
authors.initials: SS
authors.lastname: Travis
authors.forename: Marie
authors.initials: M
authors.lastname: Bernard
authors.forename: Sharon
authors.initials: S
authors.lastname: Dixon
authors.forename: William J
authors.initials: WJ
authors.lastname: McAuley
authors.forename: Gary
authors.initials: G
authors.lastname: Loving
authors.forename: Lue
authors.initials: L
authors.lastname: McClanahan
mesh_terms: D016223:Advance Directives; D000368:Aged; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D009735:Nursing Homes; D010166:Palliative Care; D012189:Retrospective Studies; D013727:Terminal Care