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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)...
Abstract
ABSTRACTObjective:

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.

Method:

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.

Results:

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.

Copyright
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: fordd@musc.edu
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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.

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Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
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