Hospice Referral Practices for Children With Cancer: A Survey of Pediatric Oncologists Kimberly Fowler, Katherine Poehling, Dean Billheimer, Rodney Hamilton, Huiyun Wu, John Mulder, Haydar Frangoul From the Department of Hematology Oncology, University of Alabama, Birmingham, AL; Departments of Hematology Oncology, Pediatrics, and Biostatistics, Vanderbilt University Medical Center; and Alive Hospice, Nashville, TN. Address reprint requests to Haydar Frangoul, MD, Vanderbilt University, 397 PRB, Nashville, TN 37232-2573; e-mail: Haydar.Frangoul@Vanderbilt.edu PURPOSE: To examine hospice referral patterns among pediatric oncologists and identify barriers to referral. METHODS: A self-administered survey was sent to 1,200 pediatric oncologists who are members of Children's Oncology Group. Two electronic mail messages followed by traditional mail surveys were sent to eligible physicians. Pediatricians and pediatric oncologists developed, pretested, and modified the survey for item clarification. RESULTS: Of 944 eligible pediatric oncologists surveyed, 632 replied, yielding a response rate of 67%. Most respondents reported having access to palliative care programs (65%) and hospice services (85%), but few (27%) had access to inpatient hospice services. More respondents reported feeling comfortable managing end-of-life pain than psychological issues (86% v 67%, respectively). Many pediatric oncologists (62%) reported that half or more of their patients died in the hospital. In multivariate analysis, physicians with access to hospice that accepts patients receiving chemotherapy had more patients die at home than in hospital compared with physicians without access to such services (P = .007). The probability of hospice referral was positively associated with the presence of a hospice facility (P < .001) and with a larger size oncology group (P = .024). Only 2.5% of respondents referred patients at the time of relapse. Continued therapy was cited as the most common reason for not making a referral, and was significantly higher when hospice did not admit children receiving chemotherapy (P = .002). CONCLUSION: Hospice referral for children with cancer is usually made late in the course of their disease and might improve if hospice admits patients who are actively receiving chemotherapy. Presented in part in the 40th Annual Meeting of the American Society of Clinical Oncology, June 5-8, 2004, New Orleans, LA. Journal of Clinical Oncology, Vol 24, No 7 (March 1), 2006: pp. 1099-1104 DOI: 10.1200/JCO.2005.02.6591 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.