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Doctor's View of Hospice Influences Talks With Patients, Study Finds

If physicians are more likely to opt for this type of care for themselves, they're more likely to discuss it

MONDAY, Dec. 16, 2013 (HealthDay News) -- Doctors who would choose hospice care for themselves if they were dying from cancer are more likely to discuss such care with patients in that situation, a new study finds.

And while the majority of doctors in the study said they would seek hospice care if they were dying from cancer, less than one-third of those said they would discuss hospice care with terminally ill cancer patients at an early stage of care.

Researchers surveyed nearly 4,400 doctors who care for cancer patients, including primary care physicians, surgeons, oncologists, radiation oncologists and other specialists. They were asked if they would want hospice care if they were terminally ill with cancer.

They were also asked when they would discuss hospice care with a patient with terminal cancer who had four to six months to live but had no symptoms: immediately; when symptoms first appear; when there are no more cancer treatment options; when the patient is admitted to hospital; or when the patient or family asks about hospice care.

In terms of seeking hospice care themselves, 65 percent of doctors were strongly in favor and 21 percent were somewhat in favor. Those who were female, who cared for more terminally ill patients or who worked in managed care settings were more likely to strongly favor hospice care for themselves. Surgeons and radiations oncologists were less likely to do so than primary care doctors or oncologists.

Only 27 percent of the doctors in the study said they would immediately discuss hospice care with a terminally ill patient who had no symptoms; 16 percent said they would wait until symptoms appeared, 49 percent would wait when no more treatment options were available, and 4 percent would wait until hospital admission or they were asked about hospice care by a patient or family member.

Nearly 30 percent of doctors who would choose hospice care for themselves said they were discuss hospice care with a patient immediately, compared with about 20 percent of other doctors, according to the study published online in JAMA Internal Medicine.

"Our results suggest that most doctors would want hospice care for themselves, but we know that many terminally ill cancer patients do not enroll in hospice," study senior author Dr. Nancy Keating, of the Harvard Department of Health Care policy, said in a Massachusetts General Hospital news release.

"Our findings suggest that doctors with more negative personal preferences about hospice care may delay these discussions with patients, which indicates they may benefit from learning more about how hospice can help their patients," she added.

"Although a physician's personal care preferences may be quite important, we still do a poor overall job having timely end-of-life care discussions with our terminally-ill cancer patients," lead author Dr. Garrett Chinn, Division of Internal Medicine at MGH, said in a hospital news release.

"A lack of knowledge about guidelines for end-of-life care for such patients, cultural and societal norms, or the continuity and quality of communication with patients and family members are also factors that might act as barriers preventing physicians from 'practicing what they preach' in end of life care," Chinn added.

More information

The American Academy of Family Physicians has more about hospice care.

SOURCE: Massachusetts General Hospital, news release, Dec. 16, 2013

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