All ETDs from UAB

Advisory Committee Chair

Marie Bakitas

Advisory Committee Members

Nataliya Ivankova

Dio Kavalieratos

J Nicholas Odom

Rodney Tucker

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


BACKGROUND: Palliative care (PC) use has been shown to offer many benefits to patients and families. Hospital PC has expanded in the United States, though growth has been limited within hospital types and geographic locations. According to the Center to Advance Palliative Care (CAPC), Alabama was rated a “D,” indicating that significant improvements in PC are needed. The purpose of this study was to develop a thorough description of access to palliative care in Alabama hospitals. METHODS: A mixed methods multiple case study was employed with quantitative data embedded into a qualitative case study approach. Four hospitals were selected based upon the existence or nonexistence of PC and additional factors. Quantitative data collection included environmental factors and a descriptive hospital survey. Qualitative data collection included semi-structured interviews and analysis of documents related to serious illness care. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using NVivo to generate codes and themes for within cases and through a cross-case analysis. RESULTS: Hospitals with PC were large, in an urban setting, nonprofit, and served multiple rural counties, while hospitals without palliative care were for-profit and served ii i a smaller catchment area, with a focus of care on surgical and maternal/child services. The impetus for PC was clinician champions, supportive hospital administration, and mission fit despite limited funding. Serious illness care at hospitals without PC was focused on end-of-life care and goals of care conversations. All hospitals used critical care rounding; however, the disciplines and discussions included in the rounds differed. Hospitals with PC included intensivists, chaplains, and a PC team member, while hospitals without PC completed case management rounding that focused on discharge planning. Serious illness and palliative care training was offered during orientation and through continuing education at hospitals with palliative care. Hospitals without palliative care offered few voluntary training opportunities related to serious illness care. CONCLUSION: Environmental factors, such as location, and hospital characteristics, such as ownership, support previous literature on the existence of PC. Factors that were present in hospitals with palliative care included palliative care champions, intensivists, multidisciplinary rounding, and focused palliative care training.

Included in

Nursing Commons



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