Barriers to the physician decision to offer hospice as an option for terminal care.

Hospice is one care alternative available to the terminally ill, but if physicians do not offer this option, it is not likely to be considered by a patient who is making end-of-life decisions. A 15-item questionnaire to determine which barriers hinder or delay a physician's decision to discuss hospice with patients was sent to 147 physicians in one area of western Wisconsin. The study population included primary care physicians (family practitioners, internists and pediatricians) and specialists (cardiologists, gastroenterologists, nephrologists, neurologists, oncologists, pulmonologists, radiation oncologists, and urologists). The barriers receiving the most citations were: "patient or family hasn't accepted the terminal diagnosis," "patient or family desires to continue life-prolonging treatment," "patient has no family or friends to help hospice provide care," and "difficult to prognosticate amount of time patient has to live." Personal interviews with 13 of the participating physicians revealed additional barriers: "concern over loss of involvement with patient," "admitting patient to hospice causes some inconvenience," "deficit in physician knowledge of local hospice program," "introduction of hospice late in course of illness," and "use of home health services instead of hospice." Knowledge of these barriers may lead to an interdisciplinary approach to ensure that patients receive information of all alternatives available for terminal care.