Barriers to hospice care and referrals: survey of physicians' knowledge, attitudes, and perceptions in a health maintenance organization.
Barriers to hospice care and referrals: survey of physicians' knowledge, attitudes, and perceptions in a health maintenance organization.
复制标题
DOI：
10.1089/1096621041349518
复制
发表时间：
2004-06-01
影响因子：
2.8
通讯作者：
Ackerson, Lynn
中科院分区：
文献类型：
--
作者：
Brickner, Leslea;Scannell, Kate;Ackerson, Lynn
INTRODUCTION: Many proponents of hospice care believe that this service is underutilized.OBJECTIVE: To determine physicians' perceptions of hospice utilization and of their own hospice referral pattern; their perceived and actual knowledge of appropriate hospice referral diagnoses; and perceived barriers to hospice referral.METHODS: Surveys for anonymous response were distributed to 125 physicians in 2 internal medicine departments of a large not-for-profit health maintenance organization (HMO). Of these 125 physicians, 89% responded, including 91 staff physicians and 20 residents.RESULTS: Of the 111 physician-respondents, 78% reported their belief that hospice care was underutilized; 84% were unable to identify appropriate hospice diagnoses; and 12% were aware of the "National Hospice Organization Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases." Difficulty of predicting death to within 6 months was cited by 37% as the foremost barrier to hospice referral. In addition, 28% expressed concern that patients or families would interpret hospice referral as a cost saving measure; 11% of respondents had been accused of using hospice referral for this purpose.CONCLUSION: Our study-the first major survey of physician attitudes and practices regarding hospice utilization in an HMO setting-showed that barriers to hospice referral are similar to those in non-HMO settings; physicians have difficulty predicting life expectancy and lack knowledge of patient eligibility guidelines. Physician concern that patients or their family members would construe hospice referral as a cost-saving technique may be a barrier particularly troublesome in an HMO setting.
