The New England Journal of Medicine features a Perspective article from Gail Gazelle M.D. this month, entitled Understanding Hospice: An Underutilized Option.

Despite increased use of hospice, many aspects of hospice care are misunderstood by patients and doctors. Contrary to popular belief, less than half of hospice patients have terminal cancer; the remainder are mostly end-stage cardiac disease. Also, many patients and doctors do not realize that hospice at home is often free, whether through Medicare or their insurers.

There are many studies cited in the article regarding the benefits of hospice care. Despite the many benefits, the median length of hospice care is only 26 days, with one-third of patients being referred only in the last week of life. One view that might contribute to this, according to the article, is the mistaken notion that patients must have a do-not-resuscitate order to enter hospice.

The most important factor causing delayed referrals, according to the article, is physician attitude. One paper from the American Society of Clinical Oncology is cited where many oncologists and doctors regard the death of patient as a failure and also do not want to destroy their patient's hope, and therefore delay hospice referral.