Training and Practice Gaps in Nursing Home Palliative Care: A Cross-Sectional Study.

BACKGROUND

Palliative care needs are prevalent among nursing home (NH) residents. However, access to and integration of palliative care services remain limited. NHs often rely on a workforce with varying levels of training and exposure to palliative care, which may influence care quality and consistency. Understanding the perspectives of NH personnel across disciplines about palliative care is essential to developing sustainable models of care.

METHODS

We conducted a cross-sectional survey of clinical employees (N = 398) at seven NHs within a single integrated health system in New York State to (1) gauge attitudes toward and knowledge about palliative care, (2) estimate the extent of engagement with advance care planning, and (3) elicit perceptions of the most valuable components of palliative care for NH residents. Median regression and ordinal logistic regression were used to assess predictors of palliative care attitudes and of checking for advance care planning documents. Disciplines were grouped into six categories for analysis: MD/NP, RN, social work/case management, rehabilitation services (PT/OT/SLP), CNAs, and LPNs.

RESULTS

While most respondents believed that palliative care improves quality of life (Median = 5, IQR 4-5), only 68% correctly identified it as distinct from hospice. Prior exposure to palliative care and favorable attitudes were associated with more frequent checking for advance care planning documents (OR = 1.75 and OR = 1.50, respectively; both p < 0.05). Attitudes varied by discipline, with physical/occupational/speech therapists reporting less favorable views than other groups (B = -0.70, p = 0.005). Respondents prioritized pain management, psychiatric symptom management, and caregiver support as areas where palliative care specialists could offer the greatest help, and further training was most desired.

CONCLUSIONS

Despite support for palliative care, gaps in knowledge and clinical engagement persist and vary by discipline. Discipline-tailored training and program design may improve palliative care delivery in NHs and help ensure more consistent, value-aligned care for residents with serious illness.