Barriers to perioperative palliative care across Veterans Health Administration hospitals: A qualitative evaluation

Palliative care remains widely underused for surgical patients, despite a clear benefit for patients with life-limiting illness or nearing the end-of-life. Interviews exploring end-of-life care among critically-ill surgical patients were conducted with providers from 14 pre-specified Veterans Affairs (VA) hospitals. Data were analyzed iteratively through steps informed by inductive and deductive descriptive content analysis. Six major domains were identified. At the patient and family level, barriers included managing expectations and goal-discordant care. At the provider-level, knowledge of and attitudes towards palliative care and provider role and identity were frequently cited barriers. At the system-level, participants identified institutional resources and culture as significant barriers. While providers recognize the importance of palliative care and end-of-life care, obstacles to its use exist at various levels. Identification of these barriers highlights areas to focus future efforts to improve the quality of palliative and end-of-life care for Veterans. •Palliative care remains underused for surgical patients, despite clear benefits.•Interviews explored end-of-life care for critically-ill surgical patients.•Barriers exist at the patient and family, provider, and system-levels.•Findings may be used to improve delivery of palliative care for surgical patients.