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American Journal of Hospice and Palliative Medicine®
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Provider Insights About Palliative Care Barriers and Facilitators: Results of a Rapid Ethnographic Assessment

Julius G. Goepp, MD

Department of Health Services Utilization Research, Lupine Creative Consulting Inc, Rochester, New York, jg{at}lupinecreative.com

Simon Meykler, BA

Department of Clinical Research, Lutheran Medical Center

Nancy E. Mooney, RN

Department of Nursing, Lutheran Medical Center

Claudia Lyon, DO

Department of Family Medicine, Lutheran Medical Center, Brooklyn, New York

Rosanne Raso, RN

Department of Nursing, Lutheran Medical Center

Kell Julliard, MA

Department of Clinical Research, Lutheran Medical Center

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.

Key Words: palliative care • ethnography • rapid ethnographic assessment • qualitative methods • diffusion of innovation

This version was published on August 1, 2008

American Journal of Hospice and Palliative Medicine®, Vol. 25, No. 4, 309-314 (2008)
DOI: 10.1177/1049909108319265
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