Physician factors in the timing of cancer patient referral to hospice palliative care

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Abstract
BACKGROUND Although physicians state that patients ideally should receive hospice care for 3 months before death, the majority of patients survive < 1 month in hospice care. In the current study, the authors attempted to determine whether the attributes of referring physicians were associated with the survival of terminally ill cancer patients in hospice. METHODS Using a prospective cohort study design, the authors observed the survival of 326 terminally ill cancer patients who were referred by 258 different physicians to 5 outpatient hospice programs in Chicago. The authors evaluated associations between patient, physician, and patient‐physician relationship factors and patient survival. RESULTS Of the 326 participating patients, 313 (96%) had known dates of death. For these patients, the median survival was 26 days. Controlling for patient demographic and disease factors, there were several physician factors found to be associated with the length of patient survival after hospice referral. For example, when a physician had referred ≥ 2 patients to hospice care in the previous 3 months, the patient survived 17 days longer in hospice compared with those patients whose physician referred fewer patients to hospice. When a physician estimated patient survival accurately (estimate obtained at the time of referral), the patient lived 20 days longer in hospice compared with those patients whose physicians made inaccurate survival estimates. The practice specialty of the physician also was found to be associated with patient survival after hospice referral, with patients referred by general internists and geriatricians living 18 days longer in hospice compared with those patients who were referred by oncologists. CONCLUSIONS In the current study, referring physician factors were found to be associated with the survival of terminally ill cancer patients after referral to hospice. Cancer 2002; 94:2733–7. © 2002 American Cancer Society. DOI 10.1002/cncr.10530