Although the vast majority of physicians participating in a multiregional study indicated that they would personally enroll in hospice care if they received a terminal cancer diagnosis, less than one-third would discuss hospice care early in the course of treating a terminally ill patient with cancer. Recent research also identified factors that increased the likelihood that clinicians would choose hospice care for themselves and examines how their preferences relate to the timing of end-of-life care discussions with patients.
“Having timely discussions with terminally ill cancer patients to establish goals for end-of-life care is important to maximize the quality of patient care. But by and large we’re not doing a good job at having these discussions early on,” says lead author Garrett Chinn, MD, MS, of the Massachusetts General Hospital Division of General Medicine in Boston. The research letter was published in JAMA Internal Medicine (2013; doi:10.1001/jamainternmed.2013.12825). “We know that patients facing terminal illness often wish to spend their remaining days at home, surrounded by loved ones. Since end-of-life care in the [United States] often stands in stark contrast to these preferences, it’s important to identify factors that may facilitate cost-effective care that supports patient preferences.”
This report reflects the answers of close to 4,400 physicians caring for patients with cancer—including primary care physicians, surgeons, oncologists, radiation oncologists, and other specialists—to two survey questions.
Respondents were asked to indicate how strongly they agreed with the statement, “If I were terminally ill with cancer, I would enroll in hospice.” They also were asked when they would discuss hospice care with an asymptomatic patient with terminal cancer who they estimated had 4 to 6 months to live—right away, when symptoms first develop, when no more options are available to treat the cancer, when the patient is admitted to the hospital, or when the patient or family asks about hospice care.
In their response to the question about personal hospice enrollment, 65% reported strong agreement with the statement, and 21% indicated they agreed somewhat. Physicians who were female, who cared for more terminally ill patients, or who worked in managed care settings were more likely to indicate strong agreement, whereas surgeons and radiation oncologists were less likely than primary care physicians or oncologists to do so.
Only 27% of respondents overall indicated they would discuss hospice care with the described patient now. Waiting until symptoms appear was the choice of 16%; when no more therapeutic options were available was indicated by 49%; and upon hospital admission or when asked by a patient or family member each were chosen by 4%. Among physicians who strongly agreed that they would personally enroll in hospice care, almost 30% responded that they would discuss hospice care with the patient now, whereas about 20% of all other respondents would do so.