| Summary: | <p> Over the past ten years, community-based palliative care (CBPC) has rapidly expanded as older adults are living in the community longer with advanced illness and high symptom burden. Yet there are no models of standardized care for this population. It has been suggested that primary and secondary palliative care be delivered in the primary care setting to address palliative care needs in the community. However, a description of older adults in primary care with advanced illness and symptom burden who would benefit from primary and secondary palliative care, and a description of the process to deliver care are lacking. The aim of this dissertation was to explore the facilitators and barriers to providing palliative care in primary care, and to describe the prevalence of advanced illness and symptoms of older adults in primary care to identify who would benefit from palliative care in primary care. </p><p> Using a grounded theory methodology, twenty semi-structured interviews were conducted with primary care and palliative care providers in academic and community settings. Four major themes emerged from the data that are facilitators and barriers in care coordination: (i) role clarity; (ii) feedback and communication; (iii) time constraint and workforce; (iv) education. </p><p> A secondary analysis was conducted using the National Ambulatory and Hospital Medical Care Surveys 2009-2011 to examine primary care visits. There were more visits by older adults to primary care for advanced illness and symptoms than to non-primary care. More visits were due to advanced COPD, CHF, dementia, pain, depression, anxiety, fatigue, and insomnia compared to non-primary care. This research contributes to our knowledge of the delivery of palliative care in the community and the patient population that could benefit from primary and specialty palliative care. I offer a conceptual model of the process of primary care and specialty palliative care in order to coordinate care for older adults with advanced illness and progressive symptomatology. </p>
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