Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Martha Polovich

Second Advisor

Dawn Aycock

Third Advisor

Nancy Kropf

Fourth Advisor

Mi-Kyung Song



Palliative Care Referral Behavior Among Nurse Practitioners In Hospital Medicine


Sharon Jackson White, PhD, RN, FNP-BC, NP-C

Palliative care incorporates holistic care, symptom management, advance care planning, strengthening of patient-family-physician communication, goals of care planning, and improved coordination of care. Healthcare providers practicing in U.S. hospitals do not always refer patients to palliative care who need it. The predominant mode of delivery of palliative care services within hospitals is the consultation service model. In such settings, palliative care services are usually initiated by request that requires a referral for the palliative care team to participate in a patient’s plan of care. Nurse practitioners (NPs) practicing within hospital medicine teams play a significant role in identifying patients who might benefit from palliative care services. The factors that influence their decision to refer patients for palliative care have not been studied. The purpose of this study was to examine the relationships among facilitators to referral, barriers to referral, self-efficacy with end of life discussions, history of referral, and referring to palliative care among NPs in hospital medicine. This study was framed by the Theory of Planned Behavior.

A cross-sectional, correlational design was used. Hospital medicine NPs were recruited using social media platforms and postal mail. Participants used Survey Monkey and paper surveys to complete questionnaires that measured demographics and the concepts of interest.

The study participants (N = 76) consisted of 5 males and 71 females with an age range from 30 to 69 (M = 41.82). The availability of the palliative care teams at their hospitals were 24/7 in person (17.1%), 24/7 hybrid of in person/phone (36.8%), and Monday – Friday day shift only in person (46.1%). Four facilitators (palliative care establishing goals of care, helping with length of stay, spiritual concerns, and when patients have serious illness and/or poor prognoses), two barriers (palliative care not routinely available and unless death is imminent), and two self-efficacy aspects (giving bad news to a patient/family member and discussing DNR orders) influenced palliative care referrals. Referral history did not influence referrals.

The findings from this study emphasize the impact of palliative care availability in NPs’ referral behavior and suggest a need for strategies to overcome this barrier.

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