Factors in the Hospice Decision

Recently, BMC Palliative Care published an unusual, but much needed, systematic review exploring the various factors influencing the patient’s hospice decision.¹ Of course, a patient’s decision as to when and whether to enroll in hospice is a sensitive matter. It is the role of clinicians to create the right environment such that patients can make decisions leading to both value-concordant care and optimal quantity & quality of life. Timely hospice utilization serves as an important factor in meeting these clinical goals. It is associated with reducing unnecessary readmissions, reducing unnecessary urgent care, reducing treatments not recommended at the end of life, lengthening survival among hospice-qualified patients, and reducing healthcare costs.² More importantly, 74% to 87% of patients in the U.S. express a preference to die at home with community-based healthcare.³ Thusly, hospice stands out as a crucial care option in providing care that is both effective and aligned with patient wishes.

A detailed understanding of the patient’s hospice decision can help physicians create the best environment for optimal decision making. Subin Choi et al. found that the following factors increase the likelihood of a patient choosing hospice.

• Family caregivers with a prior death experience: Experienced caregivers proved more likely to recommend hospice and less likely to recommend curative treatments for terminal patients, and this influenced patient choices.
• Higher income patients proved more likely to choose hospice. This may suggest additional listening and education efforts with lower-income patients. Traditional Medicare pays 100% of hospice costs, and the benefit bundles skilled care, medications, supplies, equipment, and some personal care.
• Elderly patients are more likely to prefer hospice than younger patients.
• The presence of a caregiver (and especially a caregiver who has voiced a willingness to help) makes a patient more likely to choose hospice. If a patient is unsure about their family caregiving status, consider a referral to Avatar’s hospice services. As part of our complimentary education efforts, we can help identify a potential informal caregiver and discuss hospice and the caregiver role with them. This can help clarify the appropriateness of home as the caregiving environment.
• Prognostic disclosure improves hospice participation. Patients who have not received a clear, numeric prognosis have more difficulty making healthcare decisions in keeping with their own values. On the other hand, authors have cited a need for obtaining patient permission before disclosure.
• Comprehensive understanding of all available treatment options: Patients who report understanding all treatment options prove more likely to choose hospice.
• Hospice education programs to help terminally ill patients understand the role of hospice improve hospice uptake. If a lengthy consultation is needed, providers and care planners can call Avatar for this. We will meet your patients at your office, at ours, or at their homes to answer all questions about hospice care.
• Physical decline makes hospice enrolment more likely: additional comorbidities, increasing symptom severity, and declining independence with activities of daily living.

Timely hospice referrals give patients and families more opportunity to understand their options, prepare for what lies ahead, and benefit fully from the medical, emotional, and spiritual support hospice provides. Avatar Home Health & Hospice works closely with physicians and other medical professionals throughout Greater Houston and The Woodlands to evaluate eligibility, provide patient and family education, and coordinate a smooth transition into care. Our hospice team is available 24 hours a day, 365 days a year, and responds promptly to referrals. To discuss a patient’s needs or request a hospice consultation, call Avatar at (281) 465-8220.

References

1. Choi S, Kim M, Park JE, Kang J, Woo K. Decision-making factors related to palliative care and hospice use in the community: a systematic review based on Andersen’s behavioural model of health services use. BMC Palliative Care. 2025 Dec;24(1):1-7.
2. World Health Organization. Planning and implementing palliative care services: a guide for programme managers. World Health Organization. 2016. https:// iris. who. int/ handle/ 10665/ 250584. Accessed December 18, 2025.
3. Nilsson J, Blomberg C, Holgersson G, Carlsson T, Bergqvist M, Bergström S. End‐Of‐Life care: where do cancer patients want to die? A systematic review. Asia‐Pacific Journal of Clinical Oncology. 2017 Dec;13(6):356-64.