The Perceptions of Non–Palliative Care Hospitalist Physicians Referring Patients to a Hospital Palliative Care Program

Abstract

Many hospitalized patients need holistic care, symptom management, advanced care planning, stronger patient-family-provider communication, strategic goals-of-care planning, and improved coordination of care. These services are provided by palliative care teams. Hospitalist physicians are responsible for the oversight of most hospitalized patients and for referring patients to palliative care when needed. Little is known about hospitalist physicians’ perceptions of palliative care services. A qualitative study using an interpretative phenomenological research design was conducted. Six hospitalist physicians were recruited using purposive sampling. Questions focused on assessing their experiences, facilitators, and barriers related to palliative care referrals. Their responses were transcribed and underwent thematic analysis. The findings were as follows: (a) theme 1: when hospitalist physicians want help (subthemes of when they cannot do any more/renegotiating goals of care, need of time to listen, and pain management) and (b) theme 2: barriers to referral (subthemes of family refusal, oncologists, and meaning of “palliative”). The study participants sought palliative care when they needed goals of care clarified, more time for listening to patients and families, and pain management. Barriers to palliative care included biases that some patients’ families and other physicians may have about the goals and meaning of palliative care.