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. Author manuscript; available in PMC: 2023 Sep 1.
Published in final edited form as: J Pain Symptom Manage. 2022 May 23;64(3):276–286. doi: 10.1016/j.jpainsymman.2022.05.011

Table 4.

Subthemes and Representative Quotations of Theme 3: Workforce Elements

Theme 3: Workforce Elements
Subtheme Representative Quotation
Care Continuity I think the biggest problem is that there is no continuity of care, or very little… In IHS it’s probably 50% of the docs, the providers, are going to be locums tenens. (38, IHS Leader)
When they’re on the reservation with IHS, they never see the same provider twice. And so when they go in with symptoms, and they get told to do this—well, they go in next time with the same symptoms, they get told something different. And it’s confusing and it’s just not consistent. (2, Med-Onc APP)
I feel like we get different doctors and different people that are taking care of the person, and maybe one doctor’s like, ‘we’re gonna do this.’ And then the next doctor starts all kinds of other things that weren’t actually the plan. So sometimes I don’t think everybody’s on the same page. (32, IHS RN)
And I think one of the things that kind of breeds mistrust here is lack of continuity, like not seeing the same person sequentially over time. (29, IHS APP)
Inadequate Staffing I wish we had more resources. I wish we had more providers… we’re short on nurses, we are short on a lot of things. (31, IHS Physician)
We have two public health nurses… And we only have 2 for 45,000 people. (33, IHS AHP)
If we really wanted [PC] to see, say, every single stage four patient… I don’t think [PC specialists] would have the capacity to see every single patient. (9, Med-Onc Physician)
Increased IHS Funding → Increased Staffing → Facilitates PC Program Development
You got to get more providers. Well, how do you get providers? You put money in... Nobody’s sticking around to start a program because of the chaos. There’s too much chaos and entropy to make a program run smooth. (36, IHS Physician)
The other resource limitation that could probably be overcome to help with that would be if the IHS had more funding for care access and had enough providers that a provider could actually go and care for patients at home… I think it’s going to be hard to build strong programs in the hospitals if the hospital wards themselves are disrupted or understaffed. (20, IHS Physician)
Cultural Familiarity To have a culturally competent provider in their end-of-life care is paramount to appropriate care of life or end of life. (36, IHS Physician)
When I meet with Native American patients, if I can talk a little bit about [my Native identity] and bring up those different family lines and names, people recognize them. And so there’s a lot of added trust, knowing that I am similar to them, even though I never lived on the reservation. (2, Med-Onc APP)
Having sort of a Native first, or Native person led interventions and support, really feels critical to me… I imagine that we’d offer much stronger services if the people who were offering them were Lakota. (15, IHS Physician)
I think what would help a lot and I would have appreciated is if I understood more of the Native American view on death and dying. (37, IHS Physician)