title: Barriers to physicians' decisions to discuss hospice: insights gained from the United States hospice model.
abstract: Due to its comprehensive and cost-saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. However, many physicians do not discuss hospice options until late in the disease course, when patients and their families are no longer able to benefit from hospice services. Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.
authors.affiliation: Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588-0308, USA.
authors.forename: E Kiernan
authors.initials: EK
authors.lastname: McGorty
authors.forename: Brian H
authors.initials: BH
authors.lastname: Bornstein
mesh_terms: D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003657:Decision Making; D006297:Health Services Accessibility; D006302:Health Services Research; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D010166:Palliative Care / Q000706:statistics & numerical data; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000523:psychology; D014481:United States