title: Developing palliative care practice guidelines and standards for nursing home-based palliative care teams: a Delphi study.
abstract: BACKGROUND
  Lack of nursing home (NH)-specific palliative care practice guidelines has been identified as a barrier to improving palliative and end-of-life (EOL) quality of care.
  
  
  OBJECTIVE
  The objectives of this study were to (1) assess which of the guidelines developed by the National Consensus Project, and the corresponding preferred care practices endorsed by the National Quality Forum, are important and feasible to implement in NHs; and (2) identify the operational standards for palliative care teams in NHs.
  
  
  METHODS
  Two-round mail Delphi study. Based on the existing literature, a set of 7 domains with associated 22 palliative practice guidelines was drafted. We invited 48 NH leaders, including clinicians, to review the importance (10-point Likert scale) and the feasibility (5-point Likert scale) of these guidelines. Participants were also asked about palliative care team composition rounding frequency.
  
  
  RESULTS
  The response rate to both rounds was 85%. With regard to importance, the mean rating for all guidelines was 8 or higher (ie, highly important), but there was variability in agreement with regard to 5 of the guidelines. The same 5 guidelines were also considered more difficult to implement (eg, costly, unrealistic). Overall, 17 palliative care guidelines were identified for use by NH palliative care teams. Five disciplines (social work, certified nurse assistant, nurse, physician, and nurse practitioner or physician assistant) were identified as comprising a core team and 3 were proposed as extended or ad hoc members.
  
  
  CONCLUSIONS
  The palliative care guidelines and team standards identified in this study may be helpful in providing practical direction to NH administrators and staff looking to improve palliative care practice for their residents.
authors.affiliation: Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY. Electronic address: Helena_Temkin-Greener@urmc.rochester.edu.
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
authors.affiliation: Department of Medicine, University of Rochester School of Medicine, Rochester, NY.
authors.forename: Susan
authors.initials: S
authors.lastname: Ladwig
authors.affiliation: Department of Medicine, University of Rochester School of Medicine, Rochester, NY.
authors.forename: Tom
authors.initials: T
authors.lastname: Caprio
authors.affiliation: University of Rochester, School of Nursing, Rochester, NY.
authors.forename: Sally
authors.initials: S
authors.lastname: Norton
authors.affiliation: Department of Medicine, University of Rochester School of Medicine, Rochester, NY.
authors.forename: Timothy
authors.initials: T
authors.lastname: Quill
authors.affiliation: University of Rochester, School of Nursing, Rochester, NY.
authors.forename: Tobie
authors.initials: T
authors.lastname: Olsan
authors.affiliation: Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, NY.
authors.forename: Xueya
authors.initials: X
authors.lastname: Cai
authors.affiliation: Department of Medicine, Health Policy and Research Center, University of California, Irvine, Irvine, CA.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D003697:Delphi Technique; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D009735:Nursing Homes / Q000592:standards*; D010166:Palliative Care / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D013727:Terminal Care / Q000592:standards*; D014481:United States
keywords: Palliative care; guidelines; nursing home; teams