“I've Never Thought of that Before”: Using Focused Ethnography to Explore Professional Attitudes Regarding Neonatal Palliative Care (S776)

Objectives 1. Gain increased understanding of how to advocate for palliative care programs by better understanding medical providers' and hospital administrators' views of neonatal palliative care. 2. Increase their knowledge in using focused ethnography as a program evaluation tool in palliative care. 3. Discuss relevant leadership recommendations that will address the challenges that may be present in providing neonatal palliative care. Background. Integrated interdisciplinary palliative care teams in the neonatal population can be difficult to access, inconsistent, or poorly coordinated. To create an effective neonatal palliative care program, the perspectives of stakeholders from clinical, operational, and financial domains must be included to develop an institution-specific development plan. Using a focused ethnographic program evaluation is an effective way to increase the understanding about gaps that may impact the implementation and maintenance of a neonatal palliative care program. Research Objectives. In this study, the researcher sought to gain a multidisciplinary perspective on the barriers and facilitators related to implementing a neonatal palliative care program at a tertiary, regional academic medical center in the southeast United States. Researchers sought to explore and identify the specific issues related to the intersection of clinical, operational, and financial domains. Methods. In this focused ethnography, the researcher conducted semi-structured interviews that explored the experiences of study participants related to the current care of neonates with life-threatening conditions. The perspectives of thirty-nine health-related professionals informed the identification of institutional issues that impacted the provision of neonatal palliative care at a tertiary care regional medical center. Results. Healthcare professionals interviewed described experiences that influenced their views that impacted the delivery of neonatal palliative care. Key themes included: (a) definition of palliative care, (b) uniqueness of the neonatal setting, (c) policy and protocol discrepancies across units, and (d) perception of administrative buy-in. This study offered unique insights into the conflicting perceptions held by individual stakeholders and how these misunderstandings caused significant barriers in the promotion of a successful neonatal palliative care program. Conclusions. This study highlighted the need for interdisciplinary training and communication regarding the implementation of neonatal palliative care. The results underscore the importance of recognizing the simultaneous resources needed from clinical, operational, and financial domains in order to create a successful neonatal palliative care program. Case examples from this study portray the urgency in understanding and addressing inaccurate perceptions and communication breakdowns between stakeholder groups. Implications for research, policy, or practice. The results of this study are anticipated to increase the understanding among stakeholders regarding resources and gaps that may exist within their particular medical center. Furthermore, the results from the analysis clearly underscore the importance of addressing protocols and communication discrepancies in order to create or sustain a successful neonatal palliative care program.