Discussions with Physicians about Hospice Among Patients with Metastatic Lung Cancer

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 its benefits and possibly result in earlier use.

Hospice services have been shown to improve patient management and quality of life at the close of a terminal illness, yet many terminally ill patients do not enroll in hospice care or only do so for the final days. Underenrollment may stem from a lack of awareness of hospice benefits, a lack of understanding of one’s prognosis or a choice to pursue aggressive treatment. This multi-regional study of 1,517 patients with stage IV lung cancer included interviews with patients or their surrogates four to seven months after diagnosis, a time frame to allow for a discussion with a provider about hospice.

Key Findings:

  • Half 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.
  • More than 25 percent of patients indicated that they had not discussed DNR preferences but would like to do so—evidence of “unmet demand” for end-of-life discussions.

Many patients most in need of hospice and their physicians are not communicating effectively about end-of-life care options. Incorporating a systematic assessment of patients’ need for palliative care into routine practice could help foster earlier communication.