Home Health & Hospice Week

Physician preference, rather than pa-tient preference, may be guiding hospice utilization more often than widely thought.

"Physicians often delay hospice discussions with their terminally ill patients despite guidelines recommending such discussions for patients expected to die within 1 year," says a new study in the Dec. 16 issue of JAMA Internal Medicine. "Reasons for this are not well understood," the study authors say. But "physicians’ personal preferences for hospice may influence their approach to hospice discussions with their terminally ill patients."

In a study using data from 4,368 doctors providing cancer care across the U.S., about 65 percent of doctors strongly agreed they would enroll in hospice care if they were terminally ill, reports Reuters. Another 21 percent somewhat agreed they would enroll.

Only about 27 percent of doctors said they would discuss hospice "now" with a hypothetical dying patient who had a four-to-six month prognosis, but no symptoms, however.

The other docs said they would wait to discuss hospice until the patient was hospitalized, the patient had symptoms, the patient’s family brought it up or until there were no more treatments to offer.

"It still is much lower than I think it should be," Dr. Nancy Keating, the study’s senior author, told Reuters Health. "There is a lot of concern among physicians that talking about end-of-life care with patients with advanced cancer, who have a short life expectancy, will have patients lose trust in them," she said.

"We should all be doing this a lot more," Keating said of discussing the hospice option. The study is at http://archinte.jamanetwork.com/article.aspx?articleid=1787691.