Klinton Metcalf and Katreena Collette-Merril, PhD, RN, and Kevin McEwan, MSN, RN, College of Nursing

Introduction
Patients with chronic illnesses are often plagued with multiple side effects and
secondary diagnoses that significantly limit everyday function. Managing these side
effects along with the patient’s illness often requires a multidisciplinary approach to
providing optimal care. Palliative Care is a growing field of medicine that delivers quality
symptom management for patients with complex illnesses and symptoms. Although
relatively new, evidence shows that Palliative Care interventions not only decrease the
severity of side effects during the treatment process, but also improve the quality of life
and feelings of well-being for the patient, and even extend length of survival. Palliative
Care has even proven to reduce the cost of healthcare delivered by preventing
unnecessary emergency hospitalizations and aggressive treatments. Despite its
effectiveness, however, Palliative Care remains underutilized throughout the medical
field and faces resistance in expansion. Researchers in other parts of the country show
that much of this resistance comes from a lack of education. The majority of healthcare
workers either misunderstand the purpose of Palliative Care or simply view it to be
synonymous with hospice and only consider consultation at the end of a patient’s life.
Intermountain Healthcare currently has established Palliative Care Programs located
within Utah and central Idaho. However, no research has been done to evaluate the
perception and effectiveness of those programs. The purpose of this study was to
evaluate healthcare workers’ perceptions of Palliative Care and its programs within
Intermountain. The intention was to provide concrete data that will inform and help
create possible improvements to, and potential expansion of Palliative Care Services for
the company.

Methodology
The study was conducted in two separate phases. Phase 1 consisted of one on one
interviews with physicians, nurse practitioners, care managers, and nurses, either on
site or over the phone. The respondents were asked about their understanding of
Palliative Care services, and when and how they used those services. They were asked
if they were aware of such services being provided to their patients, and how often they
personally referred, recommended, or otherwise observed those services. The
respondents were finally asked how they felt about the Palliative Care services available
to them, and what further suggestions they might have. The questions were designed to
be open-ended, allowing for responders to provide constructive feedback.
Phase 2 was conducted in the form of an online survey. 491 different healthcare
workers were randomly selected from Intermountain facilities that housed a Palliative
Care program. Unlike phase 1, the main objective of the study was to ultimately create
quality internal improvements to the services already being provided, so phase 2
focused more on gauging caregivers’ perceptions of the services provided, their
availability, and helpfulness of the staff rather than personal understanding of Palliative
Care in general. Many of the questions were restructured to allow for a fixed response
in order to provide more quantitative data, but options for free response were provided
to continue gathering qualitative feedback if the respondents were willing.

Results
32 interviews were conducted either in person or over the phone during phase 1 of the
study. Of those 32 interviews, 23 worked at facilities with dedicated Palliative Care
teams. All 23 respondents were aware of the Palliative Care teams, but majority were
only aware of the nurse practitioner members and did not know there was a physician
as a member of the team. All respondents who worked in facilities without a dedicated
Palliative Care team indicated that they would want such services available to them,
and specified that help in discussing and defining goals of care beyond end of life
situations would be most beneficial to them.
Soon after the completion of phase 1, phase 2 began with the revision of the survey and
its subsequent distribution. Currently, responses are still being collected, but 144 have
already responded and provided preliminary data. 31% of responders reported that 25%
of their patients could have benefitted from Palliative Care services. 22% felt that at
least 50% could have benefitted from such services. Overall, 95% selected either agree
or strongly agree when asked if the Palliative Care services currently provided offered
helpful care and support for patients and their families. 87% reported effective
communication between the PC teams and other staff members, while 74% indicated
that Palliative Care teams were consistently available and quick to respond. However,
only 56% selected agree/strongly agree when asked if there were an adequate number
of providers available for patient needs.

Discussion
The phase 1 interviews confirmed the data from other studies that majority of healthcare
workers misunderstand the role Palliative Care serves. 91% of responders indicated
that they understood Palliative Care to deal with end of life concerns, while only 25%
were aware that Palliative Care attended to a patient’s quality of life even if they were
not at the end stage of the disease process. Furthermore, only 19% were aware that
Palliative Care tended to the needs family members as well. Although 32 interviews
does not qualify the data as significant, it is worth noting that one of the biggest needs in
improving Palliative Care throughout Intermountain is to provide further education to
healthcare workers. Individual comments from phase 2 further indicated a glaring need
to provide clarification on the role of Palliative Care and the services it offers. Many
stated they had a clear understanding of Palliative Care, but then proceeded to describe
hospice care when asked further about their understanding. If healthcare workers had a
better understanding of the role of Palliative Care, more patients could benefit from its
services, thus improving their quality of life.

Conclusion
Although data are still being collected, the data provided has already allowed for the
current Palliative Care teams in Intermountain to begin developing ideas on how to
educate staff members about the role of Palliative Care in healthcare. Providing
education will theoretically increase demand for Palliative Care services and make a
strong case for hiring more staff to meet those needs. Eventually the data provided from
both the interviews and the survey will also lay groundwork for creating new Palliative
Care teams at other Intermountain facilities. An initial study on perceptions of Palliative
Care is only the first step, but ultimately it will allow for internal improvements to be
made within Intermountain Healthcare. This, in turn, will raise the bar of providing
quality care to patients, which really is the sentinel goal of health care.