Related Experiment Video
Updated: Feb 21, 2026

Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice
Ariel Shalev1, Veerawat Phongtankuel1, Katherine Lampa1
11 Weill Cornell Medical College, New York, NY, USA.
Background:
The transition into home hospice care is often a critical time in a patient's medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care.
Objectives:
To understand PCPs' experiences, challenges, and preferences when their patients transition to home hospice care.
Design:
Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods.
Participants:
Participants included PCPs from 3 academic group practices in New York City. Measured: Physician recordings were transcribed and analyzed using content analysis.
Results:
Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care.
Conclusions:
Primary care physicians expressed varying degrees of involvement during a patient's transition to home hospice care, but many desired to be more involved in their patient's care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.
Related Concept Videos
Continuing Care
Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
Ethical Issues
Ethical Concerns in Healthcare:
Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
Patient-centered Care

