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17385

Comparing Physician and Nurse Satisfaction and Utilization of Palliative Care: A Survey Study

Sunday, October 21, 2012: 3:00 PM
Grand Salon A6 (Hilton Riverside)
Emily S. Edlynn, Ph.D., Sabrina Derrington, MD, Jennifer Murray, CPNP, Helene Morgan, MSW and Giovanni Cucchiaro, MD, Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA

Purpose

Previous studies demonstrate that physicians and nurses bring different perspectives to end-of-life care, but this has not been explored in the context of developing a palliative care service. The purpose of this study was to evaluate and compare physician and nurse utilization and satisfaction with a new palliative care consultation service at a large, urban children’s hospital.

Methods

An online questionnaire was developed based on standard goals of palliative care and known barriers to implementation of palliative care in pediatrics. Survey questions evaluated providers’ awareness and use of the palliative care service, satisfaction, and perceived barriers to consultation. The Institutional Review Board approved the study.  The survey was administered to physicians in March 2011 and to nursing professionals in August 2011. Chi-square analysis measured differences between groups, while a variability measure for discrete variables called the Index of Qualitative Variation (IQV) characterized the dispersion of responses within each group.

Results

The response rate was 34% for physicians (n=77) and 22% for nurses (n=237).  Seventy percent (n=53) of physicians had requested palliative care consultation and 60% (n=135) of nurses had interacted with the team.  Both groups reported high levels of satisfaction, but nurses’ responses varied more widely than those of physicians. The table displays domains with the greatest difference between groups:

 

Physicians: % extremely satisfied/satisfied (IQV)

Nurses: % extremely satisfied/satisfied (IQV)

End-of-life psychosocial support

97.5% (0.65)

 78.5% (0.83)

End-of-life medical support

92.7% (0.71)

78.6% (0.8)

Psychosocial support for family

90.5% (0.41)

78.3% (0.85)

For physicians who never consulted, the most common reason selected from a list of nine options was “do not have end-of-life patients” (37%); nurses who never interacted with the service most often chose “do not have end-of-life patients “(24%) and ”do not know how to make a consult” (24%). Qualitative analysis of open-ended comments revealed that both groups recognized similar strengths (providing family and staff support; end-of-life expertise) and weaknesses of the service (communication; limited availability and staffing). Additionally, nurses highlighted a lack of education about using the service. Nurses identified increased visibility and education as ways to increase requests for palliative care.

Conclusion

Results indicated that despite high satisfaction ratings overall, nurses as a group expressed less satisfaction with the service and less knowledge about how to access palliative care. Both nurses and physicians demonstrated a misconception that palliative care focuses on end-of-life patients. A clear need exists for the program to provide more education about the scope of palliative care as encompassing all phases of treatment, as well as training for nurses about how to access palliative care.  This study provides insight into differences in physician and nurse satisfaction and utilization, and suggests steps to improve those metrics that may be helpful for young palliative care programs.