Background: Although home healthcare(HHC) clinicians increasingly provide care to a homebound population with advanced illness and high symptom burden, we know little about how HHC clinicians navigate discussions about hospice with patients and families in this setting.
Objective: We sought to explore perspectives on transition from HHC to hospice among HHC nurses and social workers.
Design: PQualitative study using semi-structured interviews and thematic analysis.
Results: Fifteen nurses and 3 Social workers participated in the study. Four main themes emerged from the interviews: (1) Regulatory Forces of Hospice and HHC; (2) Structure of HHC; (3) Individual beliefs-Hospice means giving up; and (4) Dynamics of Communication in HHC to Facilitate Transitions to Hospice.
Conclusion: Introducing the option of hospice to patients and families nearing end-of-life in the HHC setting is complex and challenging. Facilitators of hospice discussions in the HHC setting include interdisciplinary team-based clinical review, clinical decision support tools to identify patients who are hospice-eligible, and staff training. These factors provide targets for future interventions.
Keywords: end-of-life decision making; home health care; hospice; nurses; qualitative; social workers.