Family perceptions of palliative care consultations for nursing home residents

Palliative care (PC) consultations, often facilitated by providers external to nursing homes (NHs), can reduce unwanted hospitalizations and improve decision-making and communication for nursing home (NH) residents. However, limited literature has documented the specific elements within PC consultations that drive positive outcomes. Given the critical role of family members, especially for residents with cognitive impairment, this study aimed to: (1) identify actions and interactions during recent PC consultation visits, and (2) summarize family perceptions of these visits. Using a descriptive qualitative research design, family caregivers (N = 22) from five NHs across two states (Indiana and Maryland) were recruited to be interviewed within approximately one month of a PC consultation. These family caregivers had participated in a clinical trial of PC. Semi-structured interviews were transcribed, analyzed using thematic content analysis and finalized for discussions. Most family caregivers were adult children (59.1%), were female (81.9%), and Black (54.6%). Four interaction themes emerged regarding PC consultations interactions: they (1) promoted physical comfort, (2) supported family members, (3) attended to residents’ social needs, and (4) provided next steps/care planning. Four themes on perceived benefits of consultation visits were identified. Visits (1) improved residents’ quality of life, (2) provided recommendations/referrals, (3) kept family members informed, and (4) supported family members. Family caregivers had favorable impressions of PC consultation visits and provided insights into specific interactions during visits. Garnering the perspectives of family caregivers involved in PC consultations is vital for designing interventions that better support residents with cognitive impairment and their families. Findings reinforce the importance of expanding access to PC consultations in NHs that prioritize family involvement. The UPLIFT project was registered on ClinicalTrials.gov NCT04520698 on 8/17/2020.