Palliative Care-Oncology Ties Linked to Hospice Use in Cancer

The working relationship between palliative care and oncology teams may help explain why some palliative care programs transition patients with metastatic cancer to hospice more often than others, according to a multicenter qualitative study published in JAMA Internal Medicine.¹

At programs with high hospice use, that relationship was characterized by mutual trust and respect, warmth and familiarity, and empathy; at low-performing programs, investigators observed a lack of trust and familiarity and negative regard between teams. The qualitative findings describe patterns rather than proven causes.¹

Why did investigators examine relationships between teams?

Specialist palliative care has been associated with greater hospice use, but performance varies across programs.¹ In earlier work by the same group, patients with metastatic cancer treated at high hospice-use programs were nearly 50% more likely to use hospice than those treated at low hospice-use programs.² Quantitative analyses identified only geographic location and program maturity as characteristics associated with performance.^1,3

How was the study designed?

Investigators led by May Hua, MD, MS, of Columbia University in New York, New York, selected 3 high-performing (top quintile) and 3 low-performing (bottom quintile) programs based on risk-standardized hospice use among patients with metastatic cancer who received specialist palliative care.¹ One high- and 1 low-performing site were chosen in each of the Midwest, Upper South, and Deep South regions. All were at academic medical centers, and 3 were safety-net hospitals.

The team conducted 93 semistructured interviews from February 2025 to January 2026, plus 424 hours of in-person observation during site visits.¹ Participants included 45 physicians, 19 nurse practitioners, 10 social workers, 7 nurses, 4 physician assistants, 2 chaplains, and 6 patients.

What distinguished high-performing programs?

At high-performing sites, oncology clinicians understood what specialist palliative care offered, both teams valued each other's viewpoints, communication was easy and frequent, and clinicians described colleagues on the other team as "friends" or "siblings."¹ Four factors were observed alongside these relationships:

• Intentional relationship building, often prioritized by palliative care leaders
• Physical presence and proximity, such as embedding palliative care clinicians in oncology clinics or on inpatient rounds
• Real-time communication by phone or face-to-face conversation rather than notes alone
• A service-oriented mentality and a reputation for reliable service, including inpatient consults within 24 hours and urgent outpatient visits within a week

An oncology nurse practitioner at a high-performing site described drawing on the full team: "So if I put in a palliative consult, it might not be because I need their nurse practitioner to start a pain medicine, but maybe I need their nurse to go in and do pain education, and maybe I need their social worker to do some more psychosocial support."¹

A palliative care physician at another high-performing site tied usefulness to speed: "Seeing somebody in 8 weeks does not help an oncologist. So we've got to keep our bandwidth in such a way that we can get that patient in within 1 to 2 weeks. That's when we're useful."¹

What happened at low-performing programs?

At low-performing sites, oncology clinicians often conflated palliative care with hospice or limited its role to symptom management.¹ Teams communicated less often and relied more on asynchronous methods, such as electronic health record notes and messages. Staff turnover led to delays, and oncologists ended up doing much of the palliative care work themselves.

"Staffing is the biggest issue right now," an oncology nurse practitioner at a low-performing site said. "I think for a new patient appointment, if I do refer them, we're looking at least 2 to 3 months."¹

Care delivery differed as well. At high-performing sites, oncology clinicians introduced hospice early, presenting it alongside cancer-directed therapy as a reasonable choice. At low-performing sites, teams largely worked in parallel, and hospice was usually introduced late, when patients were exhausting lines of therapy.¹

What are the study's limitations?

The findings came mainly from clinicians, with only 6 patient interviews.¹ Hospice use does not capture symptoms or quality of life, and all 6 sites were academic centers, so results may not apply to community or rural settings. The study was funded by the National Cancer Institute and the National Institute on Aging.

Oncology nurses have led several efforts to widen access to palliative care, including screening tools and nurse-driven referral pathways previously covered by Oncology Nursing News.^4,5

What are the key takeaways for oncology nurses?

• Clarify roles: Explain to patients and colleagues that palliative care and hospice are not the same.
• Use the whole team: Consults can request nursing pain education, social work, or chaplain support, not only medication changes.
• Communicate in real time: Phone or in-person handoffs supported coordination at high-performing sites more than notes alone.
• Introduce hospice early: High-performing teams presented hospice as one reasonable option and revisited it over time.
• Flag access delays: Waits of weeks to months were linked to oncologists absorbing palliative care work.

References

1. Hua M, Cid M, Barshied C, et al. Effective palliative care for hospice transitions. JAMA Intern Med. 2026;186(11):1369-1379. doi:10.1001/jamainternmed.2026.4511

2. Hua M, Guo L, Ing C, Wang S, Morrison RS. Variation in palliative care program performance for patients with metastatic cancer. J Pain Symptom Manage. 2025;69(1):23-33.e2. doi:10.1016/j.jpainsymman.2024.10.021

3. Hua M, Guo L, Wang S, Morrison RS. Palliative care program characteristics and end-of-life outcomes for patients with metastatic cancer. J Pain Symptom Manage. 2025;69(6):673-681.e2. doi:10.1016/j.jpainsymman.2025.03.020

4. Childers L. Improving palliative care referrals across oncology. Oncology Nursing News. August 17, 2023. Accessed November 10, 2026. https://www.oncnursingnews.com/view/improving-palliative-care-referrals-across-oncology

5. Feraco N. Power of palliative care: how oncology nurses can increase referrals. Oncology Nursing News. February 11, 2022. Accessed November 10, 2026. https://www.oncnursingnews.com/view/power-of-palliative-care-how-oncology-nurses-can-increase-referrals