title: Barriers to providing palliative care in long-term care facilities.
abstract: OBJECTIVE
  To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors.
  
  
  METHODS
  Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses.
  
  
  METHODS
  All licensed LTC facilities in Ontario with designated medical directors.
  
  
  METHODS
  Medical directors in the facilities.
  
  
  METHODS
  Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received.
  
  
  RESULTS
  Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%).
  
  
  CONCLUSIONS
  Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. brazilk@mcmaster.ca
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.forename: Michel
authors.initials: M
authors.lastname: Bédard
authors.forename: Paul
authors.initials: P
authors.lastname: Krueger
authors.forename: Alan
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Kelley
authors.forename: Carrie
authors.initials: C
authors.lastname: McAiney
authors.forename: Christopher
authors.initials: C
authors.lastname: Justice
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004502:Education, Medical, Continuing / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006272:Health Facility Environment / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006280:Health Workforce; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D008297:Male; D009864:Ontario; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D008486:Physician Executives / Q000706:statistics & numerical data; D025341:Principal Component Analysis; D011364:Professional Practice / Q000706:statistics & numerical data*; D012112:Residential Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*