In 1999, researchers at the market research firm Gordon S. Black Corp. (now Harris Interactive), Rochester, N.Y., conducted a study to determine the factors and persons that influence physicians' decision to refer their patients to hospice.

Researchers identified factors that encourage hospice referrals ("enablers"), as well as factors discouraging hospice referrals ("barriers"), and grouped them according to their source.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Targeted End-of-Life Projects Initiative.

Key Findings: The principal investigator reported the following findings, among others, in an article in the February 2002 Journal of Palliative Medicine:

Enablers of hospice referral

• Concerning physicians and other healthcare professionals:
  • Hospice experts perceive physicians who value a collaborative and interdisciplinary approach to medicine as most likely to refer to hospice.
  • Physicians are more likely to refer to hospice and have a better understanding of palliative care if their training and continuing medical education (CME) includes end-of-life issues.
• Concerning patients and their families:
  • Educating consumers about hospice empowers them to request information on hospice from their doctors.
  • Early outreach to terminally ill patients is vital to assure a smooth transition from aggressive care to palliative and hospice care.
• Concerning the hospice system:
  • Many hospice experts believe that changes in the rules governing hospice admissions would encourage hospice referrals.

Barriers to hospice referral

• Concerning physicians and other healthcare professionals:
  • Many physicians have difficulty accepting death and are uncomfortable discussing end-of-life issues with patients and their families.
• Concerning patients and their families:
  • Like physicians, patients and families are uncomfortable confronting end-of-life issues.
• Concerning the hospice system:
  • The Medicare hospice benefit, which requires that patients eligible for hospice have six months or less to live, has narrowed the definition of "end-of-life" among health care providers.