Barriers to physicians’ decisions to discuss hospice: insights gained from the United States hospice model

Abstract

Due to its comprehensive and cost-saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. However, many physicians do not discuss hospice options until late in the disease course, when patients and their families are no longer able to benefit from hospice services. Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.

Documentation and Discussion of Preferences for Care Among Patients With Advanced Cancer

“…38 Our data also demonstrate that very few patients refused hospice care. Physicians often cite patient reluctance to consider hospice as a major barrier to hospice referral [39][40][41][42] ; however, our data suggest this may not need to be a concern.…”

A Nurse Practitioner Directed Intervention Improves the Quality of Life of Patients with Metastatic Cancer: Results of a Randomized Pilot Study

“…On the other hand, physicians may be reluctant to discuss hospice with patients because of difficulty communicating that a disease-specific treatment is futile or no longer effective, or they simply may not feel the patient will be understanding or receptive to the idea of palliative care or hospice. 8 Despite perceptions of the clinician regarding timing of hospice referral, retrospective studies have demonstrated that hospice referrals that are made too early are very rare, and are far outnumbered by referrals that come too late. 1,6 Recent data showed that a phone ARNP intervention can mitigate the decline in psychological well-being experienced by metastatic cancer patients.…”

Doctor–Patient Communication about Advance Directives in Metastatic Breast Cancer

“…[10][11][12] However, patients who have a better understanding of their prognosis and realistic expectations are more likely to receive better care and are less likely to experience end-of-life regrets. [13][14][15][16] Moreover, endof-life discussions between patient and provider do not appear to increase psychological distress, and patients who have these discussions have been shown to have a better understanding of illness severity. 17 Despite this support for more transparency with respect to end-of-life discussions, there is overwhelming evidence that palliative care is not routinely integrated into end-of-life cancer care.…”