Dussault Nicole, Ho Dorian, Dukkipati Haripriya, Vick Judith B, Skalla Lesley A, Ma Jessica, Jones Christopher A, Kaufman Brystana G
Duke University School of Medicine, Durham, NC, USA.
The University of North Carolina at Chapel Hill, USA.
Med Care Res Rev. 2025 Aug;82(4):301-318. doi: 10.1177/10775587241303963. Epub 2025 Jan 2.
While community-based palliative care (CBPC) programs have been expanding, there remain important obstacles to widespread use. Since provider perspectives on CBPC remain underexplored, we conducted a scoping review to summarize provider perspectives regarding barriers and facilitators to implementation of adult CBPC in the United States. We systematically searched OVID, MEDLINE, and CINAHL for peer-reviewed qualitative research published from January 1, 2010 to January 9, 2024, then used PRISM framework synthesis to organize themes into provider, organization, and external environment levels. Thirty-four articles were included. At the provider level, barriers included misperceptions of palliative care (PC) by referring providers and poor communication, while facilitators included multidisciplinary teams and referring provider education. At the organizational level, time constraints were barriers, while leadership buy-in and co-located clinics were facilitators. At the external environment level, limited PC workforce and inadequate reimbursement were barriers. Our findings suggest that efforts aimed at scaling CBPC must address factors at the provider, organizational, and policy levels.
虽然基于社区的姑息治疗（CBPC）项目一直在扩大，但广泛应用仍存在重要障碍。由于提供者对CBPC的看法仍未得到充分探索，我们进行了一项范围审查，以总结美国提供者对成人CBPC实施的障碍和促进因素的看法。我们系统地检索了OVID、MEDLINE和CINAHL，查找2010年1月1日至2024年1月9日发表的同行评审定性研究，然后使用PRISM框架综合法将主题组织成提供者、组织和外部环境层面。纳入了34篇文章。在提供者层面，障碍包括转诊提供者对姑息治疗（PC）的误解和沟通不畅，而促进因素包括多学科团队和转诊提供者教育。在组织层面，时间限制是障碍，而领导层的支持和同地设置的诊所是促进因素。在外部环境层面，PC劳动力有限和报销不足是障碍。我们的研究结果表明，旨在扩大CBPC规模的努力必须解决提供者、组织和政策层面的因素。
