title: Perceived barriers that impede provider relations and medication delivery: hospice providers' experiences in nursing homes and private homes.
abstract: OBJECTIVE
  Hospice providers often work with nursing home providers or with family caregivers to deliver medication services aimed at alleviating suffering in patients with life-limiting illnesses. From the perspective of hospice providers, this study explores barriers that may impede provider relations and medication delivery in nursing homes and private homes.
  
  
  METHODS
  Semistructured, open-ended interviews were conducted in-person with a purposive sample of 22 hospice providers (14 registered nurses, 4 physicians, and 4 social workers) from 4 hospice programs in the greater Chicago metropolitan area.
  
  
  RESULTS
  In general, registered nurses, doctors, and social workers discussed similar barriers in nursing homes and in private homes. According to hospice providers, nursing home providers and family caregivers exhibited comparable attitudinal barriers ("owning" their settings; "knowing what's best for the patient"; distrust toward hospice; and emotional state), and encountered similar site-readiness barriers (ill-defined hierarchy, poor communication, disagreements among care providers, and responsibility overload). Additionally, comparable alignment barriers (differences in care priority and in education/training) existed between hospice providers and care providers in nursing homes and private homes. Together, these barriers impeded care providers' communication with hospice providers and their readiness to accept hospice guidance. Overall, poor provider relations compromised the efficiency and quality of medication management, as well as potentially undermined the role of hospice providers.
  
  
  CONCLUSIONS
  From the perspectives of hospice providers, this study provides preliminary insight into barriers that multilevel interventions may need to address to improve provider relations and medication delivery in nursing homes and private homes.
authors.affiliation: Buehler Center on Aging, Health, & Society, Northwestern University, Chicago, Illinois 60611, USA. d-lau@northwestern.edu
authors.forename: Denys T
authors.initials: DT
authors.lastname: Lau
authors.forename: Jonathan
authors.initials: J
authors.lastname: Masin-Peters
authors.forename: Celia
authors.initials: C
authors.lastname: Berdes
authors.forename: Megan
authors.initials: M
authors.lastname: Ong
mesh_terms: D004358:Drug Therapy; D006282:Health Personnel; D006699:Home Care Services; D017051:Hospice Care; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D009735:Nursing Homes; D011369:Professional-Patient Relations