Shaunna Siler


Despite the significant progress in implementing palliative care interventions for cancer patients, few intervention studies seek healthcare clinicians’ input prior to implementation. The purpose of this research was then to explore palliative care and oncology clinicians’ (e.g., physicians, nurses, social workers, and chaplains) perspectives on current challenges and useful practices in meeting the quality of life needs of lung cancer patients and family caregivers, and to increase the likelihood of the adoption of a palliative care intervention based on understanding current trends in palliative care delivery at three outpatient oncology sites. The conceptual framework used for this study was the RE-AIM Model: Reach, efficacy, adoption, implementation, and maintenance of intervention research to successfully translate and sustain evidence-based practice. This was a multi-site qualitative study using focus group and key informant interviews with oncology and palliative care clinicians. Focus groups and individual phone interviews were conducted with 19 clinicians, who addressed useful practices and challenges in the following areas: (a) early palliative care; (b) interdisciplinary care planning; (c) symptom management; (d) addressing psychological and social needs; and (e) providing culturally respectful care, including spiritual care. In preparation for the intervention, specific education needs and organizational challenges were revealed through focus group and individual interviews with clinicians. These challenges included timing and staffing constraints, the need for clinician education on palliative care services to increase organizational buy-in and referrals, and support and education in providing spiritual support for patients and family caregivers. These findings highlight an important, often overlooked, step in the translation of palliative care intervention studies and may inform education and training in the areas of palliative care and spiritual care for lung cancer patients. Further, these findings pattern the adoption component of the Re-AIM Model for intervention studies in eliciting organizational support prior to implementation.

LLU Discipline





School of Nursing

First Advisor

Mamier, Iris

Second Advisor

Ferrell, Betty

Third Advisor

Winslow, Betty W.

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Palliative treatment; Nursing; Lung Neoplasms; Oncology

Subject - Local

Lung Cancer; Palliative Care; Oncology Clinicians



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website


Loma Linda University. Del E. Webb Memorial Library. University Archives