title: Hospice referral practices for children with cancer: a survey of pediatric oncologists.
abstract: OBJECTIVE
  To examine hospice referral patterns among pediatric oncologists and identify barriers to referral.
  
  
  METHODS
  A self-administered survey was sent to 1,200 pediatric oncologists who are members of Children's Oncology Group. Two electronic mail messages followed by traditional mail surveys were sent to eligible physicians. Pediatricians and pediatric oncologists developed, pretested, and modified the survey for item clarification.
  
  
  RESULTS
  Of 944 eligible pediatric oncologists surveyed, 632 replied, yielding a response rate of 67%. Most respondents reported having access to palliative care programs (65%) and hospice services (85%), but few (27%) had access to inpatient hospice services. More respondents reported feeling comfortable managing end-of-life pain than psychological issues (86% v 67%, respectively). Many pediatric oncologists (62%) reported that half or more of their patients died in the hospital. In multivariate analysis, physicians with access to hospice that accepts patients receiving chemotherapy had more patients die at home than in hospital compared with physicians without access to such services (P = .007). The probability of hospice referral was positively associated with the presence of a hospice facility (P < .001) and with a larger size oncology group (P = .024). Only 2.5% of respondents referred patients at the time of relapse. Continued therapy was cited as the most common reason for not making a referral, and was significantly higher when hospice did not admit children receiving chemotherapy (P = .002).
  
  
  CONCLUSIONS
  Hospice referral for children with cancer is usually made late in the course of their disease and might improve if hospice admits patients who are actively receiving chemotherapy.
authors.affiliation: Department of Hematology Oncology, University of Alabama, Birmingham, AL, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Fowler
authors.forename: Katherine
authors.initials: K
authors.lastname: Poehling
authors.forename: Dean
authors.initials: D
authors.lastname: Billheimer
authors.forename: Rodney
authors.initials: R
authors.lastname: Hamilton
authors.forename: Huiyun
authors.initials: H
authors.lastname: Wu
authors.forename: John
authors.initials: J
authors.lastname: Mulder
authors.forename: Haydar
authors.initials: H
authors.lastname: Frangoul
mesh_terms: D000328:Adult; D005260:Female; D019538:Health Care Surveys; D017051:Hospice Care; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010372:Pediatrics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000209:etiology / Q000628:therapy; D013727:Terminal Care; D014481:United States