title: Perspective of patients, patients' families, and healthcare providers towards designing and delivering hospice care services in a middle income Country.
abstract: BACKGROUND
  In view of the recent surge in chronic disease rates and elderly population in the developing countries, there is an urgent felt need for palliative and hospice care services. The present study investigates the views and attitudes of patients and their families, physicians, nurses, healthcare administrators, and insurers regarding designing and delivering hospice care service in a middle income country.
  
  
  METHODS
  In this qualitative study, the required data was collected using semi structured interviews and was analyzed using thematic analysis. Totally 65 participants from hospitals and Tabriz University of Medical Sciences were selected purposively to achieve data saturation.
  
  
  RESULTS
  Analyzing the data, five main themes (barriers, facilitators, strategies, attitudes, and service provider) were extracted. Barriers included financial issues, cultural-religious beliefs, patient and family-related obstacles, and barriers related to healthcare system. Facilitators included family-related issues, cultural-religious beliefs, as well as facilitators associated with patients, healthcare status, and benefits of hospice service. Most participants (79%) had positive attitude towards hospice care service. Participant suggested 10 ways to design and deliver effective and efficient hospice care service. They thought the presence of physicians, nurses, and psychologists and other specialists and clergy were necessary in the hospice care team.
  
  
  CONCLUSIONS
  Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system.
authors.affiliation: Department of Health Services Management, Health Management and Economics Research Center, University of Medical Sciences, Tehran, Iran.
authors.forename: Saber
authors.initials: S
authors.lastname: Azami-Aghdash
authors.affiliation: Department of Physiology, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Ghojazadeh
authors.affiliation: Department of Medical-Surgical Nursing, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mir Hossein
authors.initials: MH
authors.lastname: Aghaei
authors.affiliation: Department of Cardiology, Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Naghavi-Behzad
authors.affiliation: Department of Midwifery, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Zoleikha
authors.initials: Z
authors.lastname: Asgarlo
keywords: Attitudes; Developing countries; Healthcare administrator; Hospice care; Insurance official; Iran; Nurses; Patients; Patients’ families; Physicians