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Research Letter
January 2018

Palliative Care Eligibility, Symptom Burden, and Quality-of-Life Ratings in Nursing Home Residents

Author Affiliations
  • 1Department of Community Health Systems, University of California, San Francisco
  • 2Department of Physiological Nursing, San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 3Asian Health Services, Oakland, California
  • 4Division of Geriatrics, Department of Medicine, University of California, San Francisco
  • 5San Francisco Veterans Affairs Medical Center, San Francisco, California
JAMA Intern Med. 2018;178(1):141-142. doi:10.1001/jamainternmed.2017.6299

By 2030, it is projected that 40% of all US deaths will occur in nursing homes (NHs).1 Despite an estimated $136 billion spent each year, NH care has been associated with poor symptom control, low family satisfaction, and burdensome and unnecessary care transitions in the final months of life.1-3 Little is known about this vulnerable population’s specific palliative care (PC) needs. As part of a PC quality initiative, we sought to identify which NH residents were eligible for PC services, describe their characteristics, and better understand resident and family perceptions regarding symptoms and quality of life.

Between January and May 2015, all 228 residents in 3 northern California NHs were screened for PC eligibility via staff interview and medical record review using the INTERACT (version 3.0; MED-PASS) tool, Identifying Residents Who May Be Eligible for Hospice or Palliative Care/Comfort Order.4 Research assistants abstracted medical record and Minimum Data Set (MDS) data for all PC-eligible residents (n = 157). A convenience sample of PC-eligible cognitively intact residents (n = 17) and their families (n = 28) were administered the Quality of Life at the End of Life (QUAL-E) instrument and completed semistructured interviews. Only the QUAL-E findings are presented herein. The University of California, San Francisco, institutional review board deemed this to be quality improvement activity and did not require review.