Factors that influence provider relations and impede medication delivery: Hospice providers' experiences in nursing homes and private homes

BACKGROUND: Hospice providers work with care providers in multiple settings to deliver services including medication management to alleviate suffering in patients with life-limiting illnesses (e.g., they work with nursing home providers in nursing homes or with family caregivers in private homes). OBJECTIVE: To explore factors that influence provider relations and the way these relations impede hospice providers' ability to manage medications and symptoms in nursing homes and private homes. METHODS: Qualitative interviews were conducted with 22 hospice providers from 4 hospice programs in the Chicago metropolitan area. Emergent themes were analyzed according to the principles of grounded theory. RESULTS: According to hospice providers, nursing home providers and family caregivers exhibited similar psycho-emotional factors (“owning” their settings; “knowing what's best for the patient”; distrust toward hospice; and emotional state), and encountered comparable site-readiness factors (ill-defined authority structure, poor communication, disagreements among care providers, and high responsibility load). In addition, comparable alignment factors (differences in priority of care and in education/training) existed between hospice providers and care providers in their respective settings. These three sets of factors impeded how well care providers communicated with hospice providers and how ready they were to adhere to hospice prescription orders and accept hospice guidance. Overall, poor relations between providers compromised the efficiency and quality of symptom management for hospice patients and inadvertently undermined the role of hospice providers at the settings of care. CONCLUSION: This study provides insight into factors that can impede hospice medication delivery and advances our understanding of networks and caregiving research.