title: Barriers to hospice enrollment among lung cancer patients: a survey of family members and physicians.
abstract: OBJECTIVE
  Most patients diagnosed with lung cancer present with advanced stage disease and have a poor chance of long-term survival. Despite the advantages of hospice care for lung cancer patients, many are enrolled late in the course of their illness or not at all. We sought to identify reasons for this pattern.
  
  
  METHODS
  A list of perceived barriers to hospice enrollment was generated and used to create two self-administered surveys, one for physicians and one for caregivers. After focus group testing, the finalized instruments were mailed to physicians in South Carolina and to caregivers of lung cancer patients who died under hospice care with a local hospice between 2000 and 2004.
  
  
  RESULTS
  Fifty-three caregivers and 273 physicians responded to the survey. From the caregivers' perspectives, leading reasons for deferred hospice enrollment included patients' unanticipated rapid transition from well to sick and a belief that hospice means giving up hope. From the physicians' perspectives, impediments to earlier hospice enrollment included patients and caregivers overestimating survival from lung cancer and an (incorrect) assumption that patients need to be "DNR/DNI" prior to hospice enrollment.
  
  
  CONCLUSIONS
  Lung cancer patients may benefit from earlier introduction to the concepts of hospice care and more education regarding prognosis so that an easier transition in goals of care could be achieved. A smaller proportion of lung cancer patients may benefit from earlier hospice enrollment.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina29425, USA. fordd@musc.edu
authors.forename: Dee W
authors.initials: DW
authors.lastname: Ford
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.forename: Jane
authors.initials: J
authors.lastname: Zapka
authors.forename: James S
authors.initials: JS
authors.lastname: Zoller
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Silvestri
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007398:Interpersonal Relations; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data; D011159:Population Surveillance; D013022:South Carolina / Q000453:epidemiology; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology / Q000706:statistics & numerical data*; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data*