American Journal of Hospice and Palliative Medicine®, Ahead of Print.
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.ObjectiveWe sought to explore perspectives on transition from HHC to hospice among HHC nurses and social workers.DesignPQualitative 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.ConclusionIntroducing 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.