Palliative care has been shown to improve symptoms and increase quality of life in people with a life-limiting illness. Despite growth in hospital-based palliative care programs throughout the United States, only 91 hospitals have obtained The Joint Commission’s Advanced Palliative Certification. The purpose of this descriptive study was to identify how programs that do not have The Joint Commission’s Advanced Palliative Care Certification defined and conceptualized palliative care. An additional focus was to identify the barriers these programs perceived or experienced that prevented them from obtaining the advanced palliative care certification. This research program began with an evolutionary concept analysis that identified how palliative care has changed through time. Following this was a review of existing definitions and theories of palliative care. Following a comparison of various standards for palliative care, the Trajectory of Quality Palliative Care Model was developed and used to guide this research study. Hospital-based palliative care programs listed as active on the Center to Advance Palliative Care’s (CAPC) National Palliative Care Registry were eligible. A total of 21 programs across the United States participated. Data collection was completed via phone interviews guided by the Hospital-Based Palliative Care Survey. Definitions of palliative care used by the programs within the data set were inconsistent but did follow components of the definitions used by the CAPC, National Quality Forum (NQF), National Hospice and Palliative Care Organization (NHPCO), and The Joint Commission. Findings also identified perceived barriers to achieving The Joint Commission Advanced Palliative Care Certification: (a) not meeting the seven-days-per-week and on-call criteria, (b) recruitment and retention of staff, (c) allocating funding necessary to reach minimum staffing standards, and (d) hospital staff and consumer misunderstanding about palliative care. Evidence from this study provides a basis upon which further actions can be taken to address barriers to obtaining The Joint Commission’s Advanced Palliative Care Certification. Finally, this research informs potential policy implication shifts related to education and research in palliative care along with workforce training, staffing standards, and financial resources to support high-quality palliative care.

Date of publication

Fall 11-14-2019

Document Type




Persistent identifier



Nursing Ph.D

Included in

Nursing Commons