The Sowers of Seeds: A Qualitative Analysis of the Role of Palliative Care Educators in Facilitating Goals-of-Care Conversations and Palliative Care Referrals.

Background: Optimal care for seriously ill and older patients often involves advance care planning (ACP), goals-of-care (GOC) conversations, and specialty palliative care consultation, three sometimes overlapping, yet distinct practices. Insufficient staffing and investment in these areas have limited their availability.
Objectives: We explored the facilitators and barriers to successful implementation of the VIDEO-PCE trial. The intervention aimed to increase patient engagement in ACP, GOC, and by establishing Palliative Care Educators, a new clinical role integrated into existing hospital wards.
Design: This qualitative interview study employed a semi-structured interview guide tailored to the interviewee's clinical role. The interviews elicited perceptions of the facilitators and barriers to integration of palliative care educators (PCEs) into existing workflows. We developed deductive codes a priori and inductive codes as we coded interview transcripts.
Setting/subjects: Medical/surgical floor clinical colleagues, palliative care team members, and PCEs from both participating sites were interviewed.
Results: Twenty-four individuals were interviewed (12 clinical staff of medical and surgical wards, seven palliative care team members, and five PCEs). Four themes were identified: (1) The work completed by the PCEs provided a foundation for future palliative care involvement; (2) Constituting the new role in practice required revision and creativity; (3) Communication was important to providing continuity of care; and (4) Establishing trust catalyzed the acceptance of the role.
Conclusion: The creation and implementation of a new role within existing clinical workflows posed some challenges but were felt to relieve staff from some work burden and allow more patients to engage in ACP and GOC conversations.
Trial Registration: ClinicalTrials.gov Identifier: NCT04857060.
Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Angelo Volandes has a financial interest in ACP Decisions, a non-profit organization developing advance care planning video decision support tools. Dr Volandes’ interests were reviewed and are managed by MGH and Mass General Brigham in accordance with their conflicts of interest policies. Dr Aretha Delight Davis is the CEO of ACP Decisions, a nonprofit organization focused on strengthening shared decisions making through video decision aids, from which she receives a salary. None of the other authors have any conflicts of interest to disclose.