title: A Qualitative Inquiry on Palliative and End-of-Life Care Policy Reform.
abstract: BACKGROUND
  There is increasing recognition of the role of palliative care (PC) in health care delivery, but priorities for state and federal policy to support PC are unclear and have sometimes engendered controversy. We canvassed experts to shed light on general recommendations for improving PC.
  
  
  OBJECTIVE
  The study objective was to identify challenges to and potential solutions for promoting, adopting, and implementing policies that would support or expand high-quality PC.
  
  
  METHODS
  Semistructured telephone interviews were used to solicit challenges to and potential solutions for promoting, adopting, and implementing policies that would support or expand high-quality PC. Interviews were analyzed using qualitative methods. The subjects were a purposive sample of 22 professional state and federal-level advocates who work in the field of aging and/or PC.
  
  
  RESULTS
  Respondents identified four central challenges to advancing PC policies: (1) knowledge about PC in the health care setting, (2) cultural beliefs about PC, (3) payment/reimbursement for PC services, and (4) public understanding of PC. Of the wide range of solutions proposed by respondents, we present the eight most frequently discussed solutions to these challenges targeted towards policymakers, health care professionals, research, and the general public. Respondents' understanding of the relationships between problems and solutions revealed many dependencies and interconnectedness.
  
  
  CONCLUSIONS
  A qualitative approach of querying experts identified multiple significant challenges to improving and expanding PC, most of which are acknowledged in existing consensus statements. Proposed solutions were more numerous and diffuse than descriptions of the problems, signaling the need for further consensus building around actionable policy, and better understanding of how to advance a PC policy agenda.
authors.affiliation: 1 Health Services Research and Development, Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles , Los Angeles, California.
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Schreibeis-Baum
authors.affiliation: 2 RAND Health, RAND Corporation , Santa Monica, California.
authors.forename: Lea E
authors.initials: LE
authors.lastname: Xenakis
authors.affiliation: 2 RAND Health, RAND Corporation , Santa Monica, California.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Chen
authors.affiliation: 2 RAND Health, RAND Corporation , Santa Monica, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Hanson
authors.affiliation: 2 RAND Health, RAND Corporation , Santa Monica, California.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Ahluwalia
authors.affiliation: 2 RAND Health, RAND Corporation , Santa Monica, California.
authors.forename: Gery
authors.initials: G
authors.lastname: Ryan
authors.affiliation: 2 RAND Health, RAND Corporation , Santa Monica, California.|3 Center for Innovation to Implementation (Ci2i), VA Palo Alto , Palo Alto, California.|4 Section of Palliative Medicine, Stanford University School of Medicine , Stanford, California.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
mesh_terms: D026683:Advisory Committees; D018166:Health Care Reform; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D010166:Palliative Care; D036301:Qualitative Research; D058996:Quality Improvement; D013727:Terminal Care; D014481:United States