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  1. Penrod, Janice PhD, RN, FGSA, FAAN
  2. Baney, Brenda MS
  3. Loeb, Susan J. PhD, RN
  4. McGhan, Gwen MN, RN
  5. Shipley, Peggy Z. MSN, RN


The environment of care can have a profound impact on caregiving experiences of families caring for loved ones with a life-limiting illness. Care is often delivered through disease-specific specialty clinics that are shaped by the illness trajectory. In this study, the following 3 distinct cultures of care were identified: interdisciplinary, provider dominant, and cooperative network. Each of these cultures was found to express unique values and beliefs through 5 key characteristics: acknowledgment of the certainty of death, role of the formal caregiver, perception of the patient system, focus of the patient visit across the trajectory, and continuum of care across the trajectory.