Navigating Uncertainty in Serious Illness: A Grounded Theory of Palliative Care Consultation in Nursing Homes.

Abstract

Palliative care (PC) consultation has the potential to improve the quality of life of nursing home (NH) residents living with serious illness, but its implementation and impact in this setting remain variable and poorly understood. How PC consultation is enacted in NHs remains unclear, despite growing interest in integrating palliative approaches into long-term care settings. To develop a grounded theory of why and how some NHs use PC consultations from the perspective of NH staff, PC providers, and NH and PC agency leaders. A constructivist grounded theory approach was used, with a theoretical sample of key stakeholders (N = 33) semi-structured interviews to capture variability in PC consultation implementation and utilization. Data were analyzed following the Charmaz method. The core category that emerged was support for navigating uncertainty and complexity in serious illness within the context of NHs. NH staff engaged in a set of interrelated strategies to manage the core category by using PC consultation. They used PC consultation for (1) managing expectations, (2) sensemaking, (3) strategic reframing of end-of-life, and (4) addressing symptoms and preventing crises. These strategies enabled the residents, family, and NH staff to obtain comfort and ease in navigating uncertainty and complexity in serious illness. PC consultation serves as a strategic tool for NHs to navigate the uncertainty and complexities of serious illness care. Understanding and supporting the practical applications of PC consultation within NHs can lead to more effective implementation of PC consultation to enhance resident care.