Effective Palliative Care for Hospice Transitions.

High-performing specialist palliative care programs for patients with metastatic cancer in the United States show mutual trust and earlier hospice introduction by oncology clinicians.

• Why it matters: Hospice use varies across palliative care programs for cancer patients, but the program-level factors shaping this heterogeneity are unclear.
• What they did: In a multicenter qualitative study of 6 U.S. palliative care programs, investigators used a positive-negative deviance approach to select 3 high- and 3 low-performing programs, then conducted 93 interviews and 424 hours of observation.
• The result: High-performing programs had collaborative care delivery, increased access and timeliness of palliative care, and earlier hospice introduction by oncology clinicians, implying relationship-driven differences in end-of-life care processes.

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