title: Nursing Home Staff Palliative Care Knowledge and Practices: Results of a Large Survey of Frontline Workers.
abstract: BACKGROUND
  Deficits in quality end-of-life care for nursing home (NH) residents are well known. Palliative care is promoted as an approach to improve quality. The Palliative Care Survey (PCS) is designed to measure NH staff palliative care knowledge and practice.
  
  
  OBJECTIVE
  To comparing palliative care knowledge and practices across NH staff roles using the PCS, and to examine relationships between facility characteristics and PCS scores.
  
  
  METHODS
  The PCS was administered to frontline NH staff-certified nursing assistants (CNAs), licensed practical nurses (LPNs), registered nurses (RNs), and social workers (SWs)-in 51 facilities in 2012. Descriptive statistics were calculated by job role. Linear mixed effects models were used to identify facility and individual factors associated with palliative care practice and knowledge.
  
  
  RESULTS
  The analytic sample included 1200 surveys. CNAs had significantly lower practice and knowledge scores compared to LPNs, RNs, and SWs (P < 0.05). LPNs had significantly lower psychological, end-of-life, and total knowledge scores than RNs (P < 0.05 for all). Although knowledge about physical symptoms was uniformly high, end-of-life knowledge was notably low for all staff. A one-point higher facility star rating was significantly associated with a 0.06 increase in family communication score (P = 0.003; 95% CI: 0.02-0.09; SE = 0.02). Higher penetration of hospice in the NH was associated with higher end-of-life knowledge (P = 0.003; parameter estimate = 0.006; 95% CI: 0.002-0.010; SE = 0.002). Sixty-two percent of respondents stated that, with additional training, they would be interested in being leaders in palliative care.
  
  
  CONCLUSIONS
  Given observed differences in palliative care practice and knowledge scores by staff training, it appears the PCS is a useful tool to assess NH staff. Low end-of-life knowledge scores represent an important target for quality improvement.
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, Indiana, USA; Indiana University School of Medicine, Indianapolis, Indiana, USA. Electronic address: kunroe@iu.edu.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Unroe
authors.affiliation: University of Maryland-Baltimore School of Social Work, Baltimore, Maryland, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Cagle
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, Indiana, USA; Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
authors.affiliation: Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006738:Hospices / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D009728:Nursing Assistants / Q000523:psychology; D009735:Nursing Homes; D010166:Palliative Care / Q000379:methods*; D000068217:Social Workers / Q000523:psychology; D013727:Terminal Care / Q000379:methods; D055815:Young Adult
keywords: Nursing home; end of life; hospice; palliative care