Doctors Who Favor Hospice More Likely to Discuss It

Ricki Lewis, PhD

December 16, 2013

Physicians who would choose hospice care for themselves are more likely to discuss the option in a timely manner with patients than physicians who are less interested in personal hospice care, according to a research letter published online December 16 in JAMA Internal Medicine.

Many physicians delay recommending hospice care for terminally ill patients for a variety of reasons. Garrett M. Chinn, MD, from the Division of General Medicine, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, and colleagues investigated associations between physicians' personal opinions about if and when to start hospice care and how they present the possibility of hospice care to their patients.

The researchers surveyed 4368 physicians who care for patients with cancer who are enrolled in the Cancer Care Outcomes Research and Surveillance study. Using a 5-point scale, the physicians reported their degree of agreement with the question, "If I were terminally ill with cancer, I would enroll in hospice."

Participants were also asked when they would suggest hospice to an asymptomatic patient with cancer whom the physicians expected to live 4 to 6 months, choosing among starting the discussion now, when first symptoms develop, when nonpalliative treatments are exhausted, when the patient is admitted to the hospital, or only when the patient and/or family mention hospice care.

Most (64.5%) of the physicians strongly agreed that they would enroll personally in hospice if terminally ill with cancer, and 21.4% "agreed somewhat."

The answers to the timing questions may explain why hospice referrals are often delayed. Only 26.5% of respondents reported that they would bring up hospice care "now" with a patient who had 4 to 6 months to live, and 16.4% would wait until symptoms began, but 48.7% would first mention hospice care after treatments had been exhausted, 4.3% once the patient and/or family mentions it, and 4.1% if the patient is hospitalized.

Physicians who strongly agreed they would seek hospice care for themselves were more likely than other physicians to discuss hospice immediately, given the 4- to 6-month survival timeframe (odds ratio, 1.7; 95% confidence interval, 1.5 - 2.0).

Physicians were more likely to "strongly agree" to personal hospice care for terminal cancer if they were women, worked in managed care settings or primary care settings, or cared for more terminally ill patients than physicians who did not strongly agree.

"Physicians should consider their personal preferences for hospice as a factor as they care for terminally ill patients with cancer. Physicians with negative views of hospice may consider pursuing additional education about how hospice may help their patients," the researchers conclude.

A limitation of the study is its restriction to patients who have asymptomatic cancer but a prognosis of 4 to 6 months to live.

This work was supported by the National Cancer Institute and the Department of Veterans Affairs. One coauthor was funded by the National Cancer Institute. The researchers have disclosed no other relevant financial relationships.

JAMA Intern Med. Published online December 16, 2013.

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