Barriers to hospice enrollment among lung cancer patients: A survey of family members and physicians
- 1 September 2008
- journal article
- research article
- Published by Cambridge University Press (CUP) in Palliative & Supportive Care
- Vol. 6 (4), 357-362
- https://doi.org/10.1017/s1478951508000564
Abstract
Objective: 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.Keywords
This publication has 15 references indexed in Scilit:
- Late Referral to Hospice and Bereaved Family Member Perception of Quality of End-of-Life CareJournal of Pain and Symptom Management, 2005
- Barriers to Hospice Care and Referrals: Survey of Physicians' Knowledge, Attitudes, and Perceptions in a Health Maintenance OrganizationJournal of Palliative Medicine, 2004
- Hospice Use Among Medicare Managed Care and Fee-for-Service Patients Dying With CancerJAMA, 2003
- Hospice and primary care physicians: Attitudes, knowledge, and barriersAmerican Journal of Hospice and Palliative Medicine®, 2003
- Physicians and Hospice Care: Attitudes, Knowledge, and ReferralsJournal of Palliative Medicine, 2002
- Hospice Use Before DeathMedical Care, 2002
- The Hospice Decision: Psychosocial Facilitators and BarriersOMEGA - Journal of Death and Dying, 1997
- Survival of Medicare Patients after Enrollment in Hospice ProgramsThe New England Journal of Medicine, 1996
- Physician Reported Incentives and DisincentivesThe Hospice Journal, 1991
- Physicians and the Hospice DecisionThe Hospice Journal, 1988