Physician and nurse perceptions of a new inpatient palliative care consultation project: implications for education and training.
BACKGROUND
Few studies have examined ease of integrating palliative care programs into hospital culture. The purpose of this article is to report findings from focus groups conducted among physicians and nurses to elicit their perceptions of an inpatient palliative care team consultation service after 1 year of operation.


METHODS
The study consisted of four homogeneous focus groups drawn from a purposive sample of physicians (2 groups; total n = 16) and nurses (2 groups; n = 17) at a large urban managed care center. Structured interview protocols were used to elicit participant perceptions regarding the impact of implementation. Focus groups were audiotaped and transcribed verbatim. We analyzed the data using grounded theory techniques to elicit themes and subthemes.


RESULTS
Five major themes emerged regarding the positive and/or transformational impact of the program on patient/family services, medical staff, the hospital, quality of care, and time. Physician and staff observations regarding perceived barriers to integration included subthemes pertaining to the sharing of information, patient/family resistance and cultural differences, and the need for increased services.


CONCLUSIONS
The vast majority of comments expressed were related to positive aspects of the program. However, barriers exist that prevent some terminally ill patients from receiving these services. Findings from this study have implications for the need for education and training among providers on palliative and hospice services and, in particular, on the benefits of an inpatient palliative care team for patients, regardless of their attitudes toward end-of-life care programs.
Enguidanos
Susan
S
Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California 90089-0191, USA. sengui@aol.com
Housen
Patricia
P
Goldstein
Rebecca
R
Vesper
Evie
E
Allen
Janet
J
Braun
William
W
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000193:education* / Q000523:psychology; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010166:Palliative Care / Q000458:organization & administration* / Q000523:psychology; D010348:Patient Care Team / Q000458:organization & administration; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011368:Professional-Family Relations; D012017:Referral and Consultation; D019037:Urban Health Services / Q000458:organization & administration