• Nancy Dudley, Christine S Ritchie, Roberta S Rehm, Susan A Chapman, and Margaret I Wallhagen.
• 1 Department of Social and Behavioral Sciences, School of Nursing, University of California , San Francisco, California.
• J Palliat Med. 2019 Mar 1; 22 (3): 243-249.

BackgroundCommunity-based palliative care (CBPC) plays an integral role in addressing the complex care needs of older adults with serious chronic illnesses, but is premised on effective communication and collaboration between primary care providers (PCPs) and the providers of specialty palliative care (SPC). Optimal strategies to achieve the goal of coordinated care are ill-defined.ObjectiveThe objective of this study was to understand the facilitators and barriers to optimal, coordinated interdisciplinary provision of CBPC.MethodsThis was a qualitative study using a constructivist grounded theory approach. Thirty semistructured interviews were conducted with primary and palliative care interdisciplinary team members in academic and community settings.ResultsMajor categories emerging from the data that positively or negatively influence optimal provision of coordinated care included feedback loops and interactions; clarity of roles; knowledge of palliative care, and workforce and structural constraints. Facilitators were frequent in-person, e-mail, or electronic medical record-based communication; defined role boundaries; and education of PCPs to distinguish elements of generalist palliative care (GPC) and more complex elements or situations requiring SPC. Barriers included inadequate communication that prevented a shared understanding of patients' needs and goals of care, limited time in primary care to provide GPC, and limited workforce in SPC.ConclusionsOur findings suggest that processes are needed that promote communication, including structured communication strategies between PCPs and SPC providers, clarification of role boundaries, enrichment of nonspecialty providers' competence in GPC, and enhanced access to CBPC.

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