Barriers to accessing hospice services before a late terminal stage.

Although hospice care has been available in the United States for over 25 years, the trend of late terminal access persists. Quality assessments and interventions that will continue through a year of bereavement are based on early interactions and the formation of caring and trusting bonds. A qualitative research study was conducted to identify and describe barriers to timely access as perceived by those involved in hospice care: caregivers, hospice staff and volunteers, and referring physicians. Major findings include persistent knowledge deficits including misconceptions and lack of awareness of components and skill associated with hospice care: reluctance to disclose, discuss, or acknowledge patient terminality, and access of hospice care being perceived as giving up on the patient.