Oncologist Perspectives on Timely Hospice Referral: A Qualitative Study

Abstract

Introduction

Late hospice referral rates are on the rise and are associated with negative outcomes at the end of life (EoL). Rates of late hospice referral vary drastically from oncologist to oncologist, and behavioral and psychological factors among individual oncologists have been identified as potential contributors to this variability. However, there remains a lack of clarity about how these oncologist-specific factors affect hospice referral practices among oncologists.

Methods

The Communication Optimization and Methodology For Improving Oncologist Hospice Referral Timing (COMFORT) study explored oncologists’ perspectives on facilitators of and barriers to timely hospice referral. Semi-structured, qualitative interviews were conducted with 26 practicing oncologists within a large, integrated healthcare system from 6/1/2022 – 8/31/2022. Audio-recorded interviews were transcribed and analyzed using thematic analysis.

Results

Multiple themes emerged related to patient-specific factors, hospital system characteristics, oncologist knowledge of hospice care, and specialty palliative care (SPC) involvement. Commonly described barriers to timely referral included lack of adequate time with patients, challenging family dynamics, the rise of telehealth, and the finite palliative care workforce. Facilitators that were described included the presence of departmental support (nurses, social workers, hospice liaisons), and easy interdepartmental communication with SPC.

Conclusions

Numerous factors independent of hospice eligibility were reported to influence hospice referral practices among oncologists. While some factors represent challenging cultural and social barriers to timely hospice referral, other system- and patient-specific barriers offer opportunities for potential interventions.