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Oncologist Perspectives on Timely Hospice Referral: A Qualitative Study.
Andrew Lynch1, Andrea Altschuler2, Joseph P Cosgrove3
1Department of Medical Oncology, San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA.
The American Journal of Hospice & Palliative Care
|March 7, 2026
Summary
Late hospice referrals are increasing, impacting end-of-life (EoL) care. Oncologist perspectives reveal patient factors, system issues, and workforce shortages significantly influence timely hospice referrals, suggesting intervention opportunities.
Area of Science:
- Oncology
- Palliative Care
- Healthcare Management
Background:
- Late hospice referrals are a growing concern, negatively impacting end-of-life (EoL) outcomes.
- Variability in referral rates among oncologists suggests behavioral and psychological factors play a role.
- Understanding oncologist-specific factors influencing hospice referral practices is crucial.
Purpose of the Study:
- To explore oncologists' perspectives on facilitators and barriers to timely hospice referral.
- To identify key factors influencing hospice referral decisions in oncology practice.
- To inform interventions aimed at improving hospice referral timing.
Main Methods:
- Qualitative study using semi-structured interviews with 26 practicing oncologists.
- Data collected within a large, integrated healthcare system.
- Thematic analysis of transcribed audio-recorded interviews.
Main Results:
- Identified themes include patient-specific factors, hospital system characteristics, oncologist knowledge, and palliative care involvement.
- Common barriers: limited patient time, family dynamics, telehealth, and palliative care workforce shortages.
- Facilitators: departmental support (nurses, social workers) and effective interdepartmental communication with specialty palliative care (SPC).
Conclusions:
- Hospice referral practices are influenced by numerous factors beyond clinical eligibility.
- System-level and patient-specific barriers present opportunities for targeted interventions.
- Addressing cultural and social barriers is essential for improving timely hospice referrals.
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