Hospice referral decisions: the role of physicians.

In our study, we collected and evaluated the opinions of physicians in the Lowcountry of South Carolina (Berkeley, Charleston, and Dorchester counties) regarding their referrals to hospice programs and the extent of influence that their patients and families had on the decision. The research questionnaire was sent to 362 physicians who made referrals to hospice (53 percent response rate) and to 337 physicians who did not make referrals (40 percent response rate). Results revealed that medical doctors take the initiative in referrals. They felt that late referrals were due to reluctance on the part of the patient and the patient's family to admit that death was imminent. No differences were found in age, sex, medical specialty percent of terminally ill patients per practice, or initiative taken. However when the age and sex of physicians were evaluated, a statistically significant difference was found; females younger than 45 years of age were more likely to make referrals than younger males. Younger physicians were more likely to perceive that the family's reluctance to admit that death was near was a barrier to hospice referrals.