Palliative Care Leadership in Long-Term Care: Who Are the Leaders And What Are Their Capabilities?

Document Type


Publication Date

Fall 10-2018

Publication Title

22nd International Congress on Palliative Care Programme


Objectives: Leadership must be effectively integrated to promote team functioning and high quality palliative care in long-term care (LTC) homes. The purpose of this qualitative study was to describe palliative care leadership capabilities of LTC team members. The research questions were: Who are leaders in LTC palliative care delivery and what are the capabilities of these interprofessional leaders (knowledge, skills, attitudes)?

Methods: We conducted an interpretive descriptive qualitative study (Thorne, 2011) using the LEADS in a Caring Environment Framework (Dickson & Tholl, 2014) as a guiding framework. Semi-structured individual interviews were conducted with nine interprofessional and non-professional care LTC caregivers in Ontario, Canada. Interviews were audio-taped and transcribed verbatim. Data collection and analysis occurred concurrently. The data were constantly compared, coded, reduced through categorical aggregation, and interpreted to produce the findings.

Results: All participants perceived that palliative care leadership in LTC is not defined by discipline, and that it has formal and informal elements. Although registered nurses and directors of care were most frequently recognized as leaders, leadership in palliative care delivery is enacted by professional carers and non-professional carers, including family members. The overarching theme of “Having it” emerged as an overarching capability of palliative care leaders in LTC. Sub-categories included: (a) “the big and little things” such as knowing the resident, comforting physically and emotionally, and communicating physical changes, and; (b) “a heart for palliative care” which involves teaching and reaching through creative approaches, showing the way by modelling leadership, and acting with compassion.

Conclusion: Knowledge of palliative care principles, strong relational skills, and empathic attitudes are important capabilities of LTC palliative care leaders. These capabilities can be developed through role-modelling, mentorship, and collaborative practice. Palliative care policies should be co-developed with respect for the knowledge, attitudes and skills of all LTC carers, including family members.