title: Discussions with physicians about hospice among patients with metastatic lung cancer.
abstract: BACKGROUND
  Many terminally ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a health care provider could increase awareness of hospice and possibly result in earlier use.
  
  
  METHODS
  We used data on 1517 patients diagnosed as having stage IV lung cancer from a multiregional study. We estimated logistic regression models for the probability that a patient discussed hospice with a physician or other health care provider before an interview 4 to 7 months after diagnosis as reported by either the patient or surrogate or documented in the medical record.
  
  
  RESULTS
  Half (53%) of the patients had discussed hospice with a provider. Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice. Only 53% of individuals who died within 2 months after the interview had discussed hospice, and rates were lower among those who lived longer. Patients who reported that they expected to live less than 2 years had much higher rates of discussion than those expecting to live longer. Patients reporting the most severe pain or dyspnea were no more likely to have discussed hospice than those reporting less severe or no symptoms. A third of patients who reported discussing do-not-resuscitate preferences with a physician had also discussed hospice.
  
  
  CONCLUSIONS
  Many patients diagnosed as having metastatic lung cancer had not discussed hospice with a provider within 4 to 7 months after diagnosis. Increased communication with physicians could address patients' lack of awareness about hospice and misunderstandings about prognosis.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA. huskamp@hcp.med.harvard.edu
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: Yulei
authors.initials: Y
authors.lastname: He
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D002983:Clinical Competence; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000523:psychology* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010817:Physician-Patient Relations; D014342:Truth Disclosure; D014481:United States; D055815:Young Adult