Access to Community-Based Palliative Care for Older Adults with Advanced Illness

 

Purpose:Barriers exist in access to community-based palliative care for older adults nearing the end-of-life, not in hospice. Impaired access may have negative health consequences or might limit access to needed supportive symptom management. The purpose of this conceptual analysis is to explore the factors associated with access to community-based palliative care by older adults with serious and complex chronic illness.

Definition of Concept: The concept accessis defined as the degree to which older adults with serious and complex chronic illness nearing the end-of-life are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system that include community-based palliative care.

Internal Consistency of the Concept:This conceptual analysis utilized Anderson's Behavioral Model of Health Services Use (2007) to explore the individual and health system characteristics associated with access to community-based palliative care. Research studies from peer-reviewed journals (2003 to 2013) were analyzed using an adaptation of Walker and Avant's (2004) process of concept analysis.

Logic Linking Concept to Research Problem:Access to community-based palliative care for older adults with serious and complex chronic illness was associated with provider knowledge and understanding of palliative care, clarity of prognosis, and interprofessional role clarification.

Conclusions: Findings are discussed in relation to Anderson's conceptual framework of health services use regarding individual and health system characteristics associated with access to community-based palliative care and suggest the need for earlier referral. A better understanding of  the antecedents and consequences associated with access to community-based palliative care for older adults with serious and complex chronic illness is important to nursing in many ways that include promoting provider education, establishing triggers for referral, and defining the processes of care for co-management by primary care providers and the interprofessional palliative care team.