Palliative care remains underutilized in the United States. This may represent failure of translation of research into practice (diffusion of innovation). Qualitative methods can identify barriers to and facilitators of diffusion of innovation. The aim is to identify potential barriers to and facilitators of inpatient palliative care utilization at a large urban hospital, as articulated by health professionals. Rapid ethnographic assessment methods were used among health professionals with subsequent extraction of predominant themes illuminating factors influencing adoption of palliative care services. In all, 3 stakeholder categories and 7 major themes emerged. Analysis revealed consistent need for organized, cross-disciplinary education/training services and a clearly-defined team approach. Denial at all stakeholder levels and in most themes was a barrier to implementation of palliative care. Consistent, defined educational, policymaking, and procedural standards were requirements for best adoption of palliative care. Denial was a striking obstruction to diffusion of innovation.
World Health Organization.WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/ . Accessed November 26, 2005.
2.
Rady MY, Johnson DJAdmission to intensive care unit at the end-of-life: is it an informed decision ? Palliat Med. 2004;18:705-711.
3.
Barnard D., Quill T., Hafferty FW, et al. Preparing the ground: contributions of the preclinical years to medical education for care near the end of life. Working group on the pre-clinical years of the national consensus conference on medical education for care near the end of life. Acad Med.1999;74:499-505.
4.
Blake SC, Kohler S., Rask K., Davis A., Naylor DVFacilitators and barriers to 10 national quality forum safe practices. Am J Med Qual. 2006;21:323-334.
5.
Conners GP, Barker WH, Mushlin AI, Goepp JGOral versus intravenous: rehydration preferences of pediatric emergency medicine fellowship directors. Pediatr Emerg Care. 2000;16:335-338.
6.
Brajtman S.Terminal restlessness: perspectives of an interdisciplinary palliative care team. Int J Palliat Nurs. 2005;11:170-178.
7.
Groot MM, Vernooij-Dassen MJ, Crul BJ, Grol RPGeneral practitioners (GPs) and palliative care: perceived tasks and barriers in daily practice. Palliat Med. 2005;19:111-118.
8.
Kristjanson LJ, McPhee I., Pickstock S., Wilson D., Oldham L., Martin K.Palliative care nurses' perceptions of good and bad deaths and care expectations: a qualitative analysis. Int J Palliat Nurs. 2001;7:129-139.
9.
White K., Wilkes L., Cooper K., Barbato M.The impact of unrelieved patient suffering on palliative care nurses. Int J Palliat Nurs. 2004;10:438-444.
10.
de Haes H., Teunissen S.Communication in palliative care: a review of recent literature. Curr Opin Oncol. 2005;17:345-350.
11.
Detmar SB, Muller MJ, Wever LD, Schornagel JH, Aaronson NKThe patient-physician relationship. Patient-physician communication during outpatient palliative treatment visits: an observational study. JAMA. 2001;285:1351-1357.
12.
Cahana A., Arigoni F., Robert L.Attitudes and beliefs regarding the role of interventional pain management at the end-of-life among caregivers: a 4-year perspective. Pain Pract. 2007;7:103-109.
13.
Carr E.Barriers to effective pain management. J Perioper Pract. 2007;17:200-203.
14.
Kahn L., Anderson M., Perkoff GTPatient's perceptions and uses of a pediatric emergency room. Soc Sci Med. 1973;7:155-160.
15.
Pelto PJ, Pelto GHResearch designs in medical anthropology. In: Sargent CF, Johnson TM, eds. Contemporary Theory and Methods. Westport, CT: Praeger;2004:293-324.
16.
Schnitzer PKThey don't come in! stories told, lessons taught about poor families in therapy . Am J Orthopsychiatry. 1996;66:572-582.
17.
Goepp JG, Chin NP, Massad J., Edwards LAPediatric emergency department outreach: solving medical problems or revealing community solutions? J Health Care Poor Underserved. 2004;15:522-529.
18.
Davis EM, Jamison P., Brumley R., Enguidanos S.Barriers and facilitators to replicating an evidence-based palliative care model. Home Health Care Serv Q. 2006; 25:149-165.
19.
NIMH Collaborative HIV/STD Prevention Trial Group.Formative study conducted in five countries to adapt the community popular opinion leader intervention. AIDS. 2007;21(suppl 2):91S-98S.
20.
Hundt GL, Stuttaford M., Ngoma B.The social diagnostics of stroke-like symptoms: healers, doctors and prophets in Agincourt, Limpopo Province, South Africa. J Biosoc Sci . 2004;36:433-443.
21.
Guerrero ML , Morrow RC, Calva JJ, et al. Rapid ethnographic assessment of breastfeeding practices in periurban Mexico City. Bull World Health Organ . 1999;77:323-330.
22.
Coreil J., Augustin A., Holt E., Halsey NAUse of ethnographic research for instrument development in a case-control study of immunization use in Haiti. Int J Epidemiol.1989;18:33S-37S.
23.
Bentley ME, Pelto GH, Straus WL et al. Rapid ethnographic assessment: applications in a diarrhea management program. Soc Sci Med. 1988;27:107-116.
24.
Bern-Klug M. , Gessert CE, Crenner CW, Buenaver M., Skirchak D.Getting everyone on the same page: nursing home physicians' perspectives on end-of-life care. J Palliat Med. 2004;7:533-544.
25.
Chao CS, Chen CH, Yen M.The essence of spirituality of terminally ill patients. J Nurs Res. 2002;10:237-245.
26.
Georges JJ, Grypdonck M., Dierckx de CB. Being a palliative care nurse in an academic hospital: a qualitative study about nurses' perceptions of palliative care nursing. J Clin Nurs. 2002;11:785-793.
27.
Quinn H., Allan H., Bryan K.An evaluation of dependency assessment: experiences of staff, patients and carers in a UK hospice. Int J Palliat Nurs. 2004;10:592-599.
28.
Munoz-Plaza CE, Strauss SM, Astone-Twerwll JM, Des J., Hagan H.Staff perspectives on facilitating the implementation of hepatitis C services at drug treatment programs. J Psychoactive Drugs. 2006;38:233-241.
29.
Henderson AJ , Davies J., Willet MRThe experience of Australian project leaders in encouraging practitioners to adopt research evidence in their clinical practice. Aust Health Rev. 2006;30:474-484.
