title: Physician factors that influence patient referrals to end-of-life care.
abstract: To identify factors associated with physician referrals to end-of-life (EOL) care.
  
  
  
  Cross-sectional, web-based survey.
  
  
  
  Participants were managed care physicians (n = 545) from the Southern California region of a national nonprofit health maintenance organization who treated a patient in their office within 6 months of the patient's death from a chronic condition. Measures included self-reports of referrals to EOL services, comfort level discussing EOL with patients, personal/family experience with hospice, and demographic characteristics.
  
  
  
  Participants were most commonly US born (69.1%), married (83.8%), and male (66.0%) with a mean age of 47 years (SD = 8.9 years). About half were Caucasian (51.7%). Logistic regression revealed that family/internal medicine physicians were nearly 9 times more likely to make EOL referrals (95% confidence interval [CI] 3.879-19.434), and physicians comfortable discussing EOL care were nearly 7 times more likely to refer (95% CI 3.465-12.750). Younger age was significantly associated with EOL referrals; with every 1-year decrease in age, physicians were 5% more likely to refer (95% CI 0.911-0.985). Family/internal medicine physicians (95% CI 1.259-2.899) and those comfortable discussing EOL care (95% CI 2.964-9.685) were also more likely to make frequent (4 or more) referrals
  
  
  
  This study highlights factors associated with EOL referrals that may be enhanced at the organizational level through training and educating physicians. Results suggest that organizations should work toward improving physician ease and comfort with EOL conversations. This study serves as an important step toward understanding and reducing physician-level barriers to EOL referrals.
authors.affiliation: Davis School of Gerontology, University of Southern California, 3715 McClintock Ave, Los Angeles, CA 90089, USA. acoulour@usc.edu
authors.forename: Alexis Coulourides
authors.initials: AC
authors.lastname: Kogan
authors.forename: Richard
authors.initials: R
authors.lastname: Brumley
authors.forename: Kathleen
authors.initials: K
authors.lastname: Wilber
authors.forename: Susan
authors.initials: S
authors.lastname: Enguidanos
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012737:Sex Factors; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data*