{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T11:06:54Z","timestamp":1779188814883,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"This study was supported by Kaiser Permanente Northern California Community Health."}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Late hospice referral rates are on the rise and are associated with negative outcomes at the end of life (EoL). Rates of late hospice referral vary drastically from oncologist to oncologist, and behavioral and psychological factors among individual oncologists have been identified as potential contributors to this variability. However, there remains a lack of clarity about how these oncologist-specific factors affect hospice referral practices among oncologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Communication Optimization and Methodology For Improving Oncologist Hospice Referral Timing (COMFORT) study explored oncologists\u2019 perspectives on facilitators of and barriers to timely hospice referral. Semi-structured, qualitative interviews were conducted with 26 practicing oncologists within a large, integrated healthcare system from 6\/1\/2022 \u2013 8\/31\/2022. Audio-recorded interviews were transcribed and analyzed using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multiple themes emerged related to patient-specific factors, hospital system characteristics, oncologist knowledge of hospice care, and specialty palliative care (SPC) involvement. Commonly described barriers to timely referral included lack of adequate time with patients, challenging family dynamics, the rise of telehealth, and the finite palliative care workforce. Facilitators that were described included the presence of departmental support (nurses, social workers, hospice liaisons), and easy interdepartmental communication with SPC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Numerous factors independent of hospice eligibility were reported to influence hospice referral practices among oncologists. While some factors represent challenging cultural and social barriers to timely hospice referral, other system- and patient-specific barriers offer opportunities for potential interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091261424422","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T15:26:19Z","timestamp":1773242779000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Oncologist Perspectives on Timely Hospice Referral: A Qualitative Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0333-1879","authenticated-orcid":false,"given":"Andrew","family":"Lynch","sequence":"first","affiliation":[{"name":"Kaiser Permanente Northern California, San Francisco, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Altschuler","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph P.","family":"Cosgrove","sequence":"additional","affiliation":[{"name":"Department of Geriatrics and Continuing Care, The Permanente Medical Group, Pleasanton, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Pleasanton, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corey","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Vallejo Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"Liu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, San Francisco, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina","family":"Chang","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Redwood City, CA, USA"},{"name":"Hospice East Bay"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2006.10.010"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.18604"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22413"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.0851"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2004.05.003"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2009.05.001"},{"key":"e_1_3_4_8_2","article-title":"NHPCO facts and figures: hospice care in America","author":"National Hospice and Palliative Care Organization","year":"2007","unstructured":"National Hospice and Palliative Care Organization. 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