Where Hospice Fails Us: A Qualitative Study of Facilitators and Barriers in Transitions to Hospice According to Palliative Care Clinicians.

Abstract

Transitions to hospice are challenging for patients, caregivers, and health care teams, yet few studies have examined gaps in care from the perspectives of referring palliative care (PC) clinicians. To identify facilitators and barriers in hospice transitions described by PC clinicians. Qualitative study using semi-structured interviews focused on hospice transitions. Ten referring PC clinicians (physicians, advanced practice providers, and a social worker) at a large academic health center. Interviews were transcribed and analyzed using thematic content analysis. Clinicians emphasized the value of hospice and the Medicare benefit, while identifying barriers to hospice transitions. Challenges included inadequate caregiving support, limited reimbursement, uncertainty around eligibility and prognostication, and differences between for-profit and non-profit hospice agencies. These barriers contributed to inequitable access to hospice and gaps in care. PC clinicians identify substantial barriers to hospice transitions, underscoring the need to improve access to comprehensive end-of-life care.