Oncologist Perspectives on Timely Hospice Referral: A Qualitative Study.

Authors

Andrew Lynch, Andrea Altschuler, Joseph P Cosgrove, Hannah Whitehead, Corey Schwartz, Raymond Liu, Mina Chang

Published in

The American journal of hospice & palliative care. Pages 10499091261424422. Mar 07, 2026. Epub Mar 07, 2026.

Abstract

IntroductionLate hospice referral rates are on the rise and are associated with negative outcomes at the end of life (EoL). Rates of late hospice referral vary drastically from oncologist to oncologist, and behavioral and psychological factors among individual oncologists have been identified as potential contributors to this variability. However, there remains a lack of clarity about how these oncologist-specific factors affect hospice referral practices among oncologists.MethodsThe Communication Optimization and Methodology For Improving Oncologist Hospice Referral Timing (COMFORT) study explored oncologists' perspectives on facilitators of and barriers to timely hospice referral. Semi-structured, qualitative interviews were conducted with 26 practicing oncologists within a large, integrated healthcare system from 6/1/2022 - 8/31/2022. Audio-recorded interviews were transcribed and analyzed using thematic analysis.ResultsMultiple themes emerged related to patient-specific factors, hospital system characteristics, oncologist knowledge of hospice care, and specialty palliative care (SPC) involvement. Commonly described barriers to timely referral included lack of adequate time with patients, challenging family dynamics, the rise of telehealth, and the finite palliative care workforce. Facilitators that were described included the presence of departmental support (nurses, social workers, hospice liaisons), and easy interdepartmental communication with SPC.ConclusionsNumerous factors independent of hospice eligibility were reported to influence hospice referral practices among oncologists. While some factors represent challenging cultural and social barriers to timely hospice referral, other system- and patient-specific barriers offer opportunities for potential interventions.

PMID:
41793199
Bibliographic data and abstract were imported from PubMed on 07 Mar 2026.

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