The Asco Post

Most Physicians Would Enroll in Hospice If They Were Terminally Ill With Cancer, Study Finds

By Matthew Stenger
Posted: 1/7/2014 4:20:32 PM
Last Updated: 1/7/2014 4:20:32 PM

Key Points:
  • Female physicians, primary care physicians, physicians with more patients in managed care, and those with more terminally ill patients were more likely to report a strong preference for hospice enrollment if they were terminally ill with cancer.
  • Physicians with a strong preference for hospice for themselves were more likely to have earlier discussions of hospice with their terminally ill patients.

In a research letter published in JAMA Internal Medicine, Chinn et al surveyed physicians’ attitudes towards hospice treatment if they were terminally ill with cancer and assessed how physician preferences might affect timing of hospice discussions with their terminally ill patients. They found that most physicians reported that they would enroll in hospice, particularly women, primary care physicians, those with more patients in managed care, and those with more terminally ill patients. Physicians with strong preference for hospice were more likely to have earlier hospice discussions with their patients.

Study Details

The study involved 4,368 responding physicians caring for cancer patients in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Physicians were asked to indicate on a 5-point Likert scale how strongly they agreed or disagreed with the statement “If I were terminally ill with cancer, I would enroll in hospice.”

On the basis of a scenario in which they were caring for an asymptomatic patient with advanced cancer who they believed had 4 to 6 months to live, they were also asked to indicate whether they would discuss hospice with the patient “now,” “when the patient first develops symptoms,” “when there are no more nonpalliative treatments to offer,” “only if the patient is admitted to the hospital,” or “only if the patient and/or family bring it up.” The survey response rate was 61%.

Among all respondents, 80% were male; 41% were primary care physicians, 22% were surgeons, 14% were medical oncologists, 6% were radiation oncologists, and 18% were in other specialties; 58% had ≤ 50% of patients in managed care; and 46% had seen > 12 terminally ill patients in the past year.

Majority Would Enroll in Hospice

Strong agreement that they would enroll in hospice if terminally ill with cancer was expressed by 64.5% of all physicians; 65.4% to 67.1% of those aged ≤ 39 to 59 years and 57.7% of those aged ≥ 60 years; 69.5% of primary care physicians, 56.6% of surgeons, 70.3% of medical oncologists, 57.6% of radiation oncologists, and 61.2% of those in other specialties; 60.8% of those with ≤ 50% of patients in managed care and 69.8% of those > 50% in managed care; and 62.5% of those who had ≤ 12 terminally ill patients in the past year and 67.1% of those who had > 12 terminally ill patients.

In multivariate analysis adjusting for age, sex, specialty, patients in managed care, number of terminally ill patients, and type of practice, strong agreement with hospice enrollment was significantly more likely for women vs men (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.48–2.18), physicians with > 50% of patients vs ≤ 50% of patients in managed care (OR = 1.30, 95% CI = 1.12–1.51), and physicians with > 12 vs ≤ 12 terminally ill patients (OR = 1.29, 95% CI = 1.12–1.50). Strong agreement with hospice enrollment was significantly less likely for surgeons (OR = 0.65, 95% CI = 0.55–0.78), radiation oncologists (OR = 0.57, 95% CI 0.42–0.76), and physicians in other specialties (OR = 0.75, 95% CI = 0.62–0.90) compared with primary care physicians.

Earlier Discussion of Hospice

Overall, 26.5% of physicians indicated that they would discuss hospice “now” with a patient who they believed had 4 to 6 months to live, 16.4% indicated they would wait until the patient was symptomatic, 48.7% would wait until there were no more treatments to offer, 4.3% would wait until patient or family raised the topic, and 4.1% would wait until the patient was hospitalized. After adjustment for other variables, physicians who strongly agreed that they would enroll themselves in hospice were significantly more likely to report discussing hospice “now” (OR = 1.7, 95% CI = 1.5–2.0).  

The authors concluded, “Physicians should consider their personal preferences for hospice as a factor as they care for terminally ill patients with cancer. Physicians with negative views of hospice may consider pursuing additional education about how hospice may help their patients.”

Nancy L. Keating, MD, MPH, of Harvard Medical School, is the corresponding author for the JAMA Internal Medicine article.

The study was supported by grants from the National Cancer Institute.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.

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