Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 12
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Lu, Ching-Yi Shen, Wen-Chi Kao, Chen-Yi Wang, Hung-Ming Tang, Shu-Chuan Chin, Tsu-Ling Chi, Chuan-Chuan Yang, Jin-Mei Chang, Chih-Wen Lai, Ying-Fen Yeh, Ya-Chi Hung, Yu-Shin and Chou, Wen-Chi 2016. Impact of Palliative Care Consultation Service on Terminally Ill Cancer Patients. Medicine, Vol. 95, Issue. 10, p. e2981.

    Schulman-Green, Dena Linsky, Sarah Jeon, Sangchoon Kapo, Jennifer Blatt, Leslie and Chagpar, Anees 2016. Integrating palliative care into self-management of breast cancer: Protocol for a pilot randomized controlled trial. Contemporary Clinical Trials, Vol. 48, p. 133.

    Slomka, Jacquelyn Prince-Paul, Maryjo Webel, Allison and Daly, Barbara J. 2016. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions. Journal of the Association of Nurses in AIDS Care, Vol. 27, Issue. 4, p. 476.

    Ford, Marvella E Wei, Wei Moore, Leslie A Burshell, Dana R Cannady, Kimberly Mack, Franshawn Ezerioha, Nnadozie Ercole, Kelley and Garrett-Mayer, Elizabeth 2015. Evaluating the reliability of the Attitudes to Randomized Trial Questionnaire (ARTQ) in a predominantly African American sample. SpringerPlus, Vol. 4, Issue. 1,

    Iranmanesh, Sedigheh Razban, Farideh Tirgari, Batool and Zahra, Ghazanfari 2014. Nurses' knowledge about palliative care in Southeast Iran. Palliative and Supportive Care, Vol. 12, Issue. 03, p. 203.

    Chou, Wen-Chi Hung, Yu-Shin Kao, Chen-Yi Su, Po-Jung Hsieh, Chia-Hsun Chen, Jen-Shi Liau, Chi-Ting Lin, Yung-Chang Liaw, Chuang-Chi and Wang, Hung-Ming 2013. Impact of palliative care consultative service on disease awareness for patients with terminal cancer. Supportive Care in Cancer, Vol. 21, Issue. 7, p. 1973.

    Bonomi, Marcelo R. Smith, Cardinale B. Mhango, Grace and Wisnivesky, Juan P. 2012. Outcomes of elderly patients with stage IIIB–IV non-small cell lung cancer admitted to the intensive care unit. Lung Cancer, Vol. 77, Issue. 3, p. 600.

    Schulman-Green, Dena Ercolano, Elizabeth Jeon, Sangchoon and Dixon, Jane 2012. Validation of the Knowledge of Care Options Instrument To Measure Knowledge of Curative, Palliative, and Hospice Care. Journal of Palliative Medicine, Vol. 15, Issue. 10, p. 1091.

    Catlin, Anita 2011. Transition From Curative Efforts to Purely Palliative Care for Neonates. Advances in Neonatal Care, Vol. 11, Issue. 3, p. 216.

    Ford, Marvella E. Wahlquist, Amy E. Ridgeway, Celina Streets, June Mitchum, Katie A. Harper, R. Remus Hamilton, Ian Etheredge, J. James W. Jefferson, Melanie S. Varner, Heidi Campbell, Katora and Garrett-Mayer, Elizabeth 2011. Evaluating an intervention to increase cancer knowledge in racially diverse communities in South Carolina. Patient Education and Counseling, Vol. 83, Issue. 2, p. 256.

    Hui, David Elsayem, Ahmed Li, Zhijun De La Cruz, Maxine Palmer, J. Lynn and Bruera, Eduardo 2010. Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center. Cancer, Vol. 116, Issue. 8, p. 2036.

    Zhang, Amy Y. Zyzanski, Stephen J. and Siminoff, Laura A. 2010. Differential patient–caregiver opinions of treatment and care for advanced lung cancer patients. Social Science & Medicine, Vol. 70, Issue. 8, p. 1155.


Barriers to hospice enrollment among lung cancer patients: A survey of family members and physicians

  • Dee W. Ford (a1), Paul J. Nietert (a2), Jane Zapka (a2), James S. Zoller (a3) and Gerard A. Silvestri (a1)
  • DOI:
  • Published online: 13 November 2008

Most patients diagnosed with lung cancer present with advanced stage disease and have a poor chance of long-term survival. Despite the advantages of hospice care for lung cancer patients, many are enrolled late in the course of their illness or not at all. We sought to identify reasons for this pattern.


A list of perceived barriers to hospice enrollment was generated and used to create two self-administered surveys, one for physicians and one for caregivers. After focus group testing, the finalized instruments were mailed to physicians in South Carolina and to caregivers of lung cancer patients who died under hospice care with a local hospice between 2000 and 2004.


Fifty-three caregivers and 273 physicians responded to the survey. From the caregivers' perspectives, leading reasons for deferred hospice enrollment included patients' unanticipated rapid transition from well to sick and a belief that hospice means giving up hope. From the physicians' perspectives, impediments to earlier hospice enrollment included patients and caregivers overestimating survival from lung cancer and an (incorrect) assumption that patients need to be “DNR/DNI” prior to hospice enrollment.

Significance of results:

Lung cancer patients may benefit from earlier introduction to the concepts of hospice care and more education regarding prognosis so that an easier transition in goals of care could be achieved. A smaller proportion of lung cancer patients may benefit from earlier hospice enrollment.

Corresponding author
Address correspondence and reprint requests to: Dee W. Ford, Medical University of South Carolina, 96 Jonathan Lucas Street, 812-CSB, Charleston, SC 29425. E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

L. Brickner , K. Scannell & S. Marquel (2004). Barriers to hospice care and referrals: Survey of physicians' knowledge, attitudes, and perceptions in a health maintenance organization. Journal of Palliative Medicine, 7, 411418.

H. Chen , W.E. Haley & B.E. Robinson (2003). Decisions for hospice care in patients with advanced cancer. Journal of the American Geriatrics Society, 51, 789797.

N.A. Christakis & J.J. Escarce (1996). Survival of medicare patients after enrollment in hospice programs. New England Journal of Medicine, 335, 172178.

D.S. Gochman & G.S. Bonham (1988). Physicians and the hospice decision: Awareness, discussions, reasons, and satisfaction. The Hospice Journal, 4, 2553.

R.B. Hyman & W. Bulkin (1990). Physician reported incentives and disincentives for referring patients to hospice. The Hospice Journal, 6, 3964.

E.P. McCarthy , R.B. Burns & R.B. Davis (2003a). Barriers to hospice care among older patients dying with lung and colorectal cancer. Journal of Clinical Oncology, 21, 728735.

E.P. McCarthy , R.B. Burns & Q. Ngo-Metzger (2003b). Hospice use among Medicare managed care and fee-for-service patients dying with cancer. JAMA, 289, 22382245.

E.P. McCarthy , R.S. Phillips & Z. Zhong (2000). Patients' experiences as death approaches. Journal of the American Geriatrics Society, 48(5 Suppl), S110S121.

K.S. Ogle , B. Mavis , (2002). Physicians and hospice care: Attitudes, knowledge, and referrals. Journal of Palliative Medicine, 5, 8592.

K. Ogle , B. Mavis & T. Wang (2003). Hospice and primary care physicians: Attitudes, knowledge, and barriers. American Journal of Hospice and Palliative Care, 20, 4551.

E.R. Schockett , J.M. Teno & S.C. Miller (2005). Late referral to hospice and bereaved family member perception of quality of end-of-life care. Journal of Pain and Symptom Management, 30, 400407.

M.J. Stillman & K. Syrjala (1999). Differences in physician access to patterns to hospice care. Journal of Pain and Symptom Management, 17, 157163.

S.T. Tang (2003). Determinants of hospice home care use among terminally ill cancer patients. Nursing Research, 52, 217225.

B.A. Virnig , A.M. McBean & S. Kind (2002). Hospice use before death. Medical Care, 40, 7378.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *