Late Referrals to Hospice: Clinical (PICOT) Question


Late referrals to hospice have severe consequences as the lack of timely medical help results in conditions worsening and irreversible damage for patients with chronic diseases. Indeed, individuals with oncologic diseases require pain management, nursing practitioners’ (NPs) assistance, and access to palliative care for basic live support (Allsop et al., 2018). Adults with advanced cancer conditions depend on the referral timing and the intervention, such as using a screening questionnaire and repeated conversations with clients is the proposed solution. Therefore, the PICOT question is, “In adults with advanced cancer (P), how effective is the implementation of screening questionnaires and extended conversations (I) compared to no intervention (C) in preventing late referrals to hospice (O) within one year (T)?” This paper aims to describe the PICOT question’s influence on different aspects, such as nursing practice and patient care.

Evidence-Based Solution

The intervention’s success will be significantly increased if the evidence-based solution is developed and applied. For instance, identifying an optimal hospice referral timing for patients with cancer considering the combination of theoretical knowledge and practical experience is necessary for a workable strategy (Tobin et al., 2021). Moreover, as the PICOT question compares with a no-intervention group, research and evidence gathering about populations and their specific conditions can help make better conclusions and adjust the activities.

Nursing Intervention

The intervention is based on providing patients with additional conversations about their conditions and enabling them to fill in advanced screening questionnaires; NPs participate in both activities and can positively influence the outcomes. Working with adults with advanced cancer requires exploring their history, identifying patterns, risks, and estimated time for referring them to hospice (Tobin et al., 2021). Nurses can improve the quality of conversations by studying the patients’ conditions and selecting the specific topics to discuss rather than following a generalized scenario.

Patient Care

Late referrals to hospice care have serious negative consequences for patients with diverse conditions, and an intervention based on a specific disease and population is beneficial for the outcomes improvement in general. Dealing with serious illness without professional assistance and nursing surveillance can shorten individuals’ lives and result in additional costs in the worsening conditions (Kirk et al., 2019). The PICOT question identifies that cancer treatment is to be studied, and chronic pain management, emergencies, and health assessment practices related to patient care intervention are improved.

Health Care Agency

Health care agencies are responsible for the recourses sufficiency in the hospices, providing the doctors and nurses with opportunities to timely refer clients to the relevant hospital units. Oncological patients’ conditions development is unpredictable; thus, organizations must have reserve wards and a workforce (Mulville et al., 2019). Consequently, addressing the issue described in the PICOT question can enable the health care agencies to improve and optimize their workflows and schedules and fill the shortage of vital medication and tools.

Nursing Practice

Nursing practitioners’ work in palliative care is crucial for maintaining patients’ conditions at their best, and the intervention to decrease the number of late referrals can significantly improve their practice. Furthermore, NPs influence the recommendation for a client to be sent to a hospice, and evidence-based decision-making should be taught to them for better outcomes (Giezendanner et al., 2018). The intervention might compare if the additional course about referrals’ timing resulted in a more accurate assignment to hospice than if no extra knowledge was offered.


The PICOT question approach is valuable for identifying the intervention’s key actions, populations to influence, and the timing to make conclusions regarding the strategy’s effectiveness. Implementing screening questionnaires and extended conversations compared to no intervention in preventing late referrals to hospice within one year in adults with advanced cancer is beneficial for patients and health care organizations. Nursing practitioners’ interaction with clients combined with evidence-based decisions regarding assigning them to palliative care will enable the organizations to optimize their recourses and establish additional regulations to prevent shortages.


Allsop, M. J., Ziegler, L. E., Mulvey, M. R., Russell, S., Taylor, R., & Bennett, M. I. (2018). Duration and determinants of hospice-based specialist palliative care: A national retrospective cohort study. Palliative Medicine, 32(8), 1322-1333. Web.

Giezendanner, S., Bally, K., Haller, D. M., Jung, C., Otte, I. C., Banderet, H. R., & Gudat, H. (2018). Reasons for and frequency of end-of-life hospital admissions: General practitioners’ perspective on reducing end-of-life Hospital referrals. Journal of Palliative Medicine, 21(8), 1122-1130. Web.

Kirk, M. A., Hanson, L. C., Weinberger, M., Haines, E. R., Rokoske, F. S., Powell, B. J., & Birken, S. A. (2019). Pilot test of an adapted intervention to improve the timeliness of referrals to hospice and palliative care for eligible home health patients. Journal of Palliative Medicine, 22(10), 1266-1270. Web.

Mulville, A. K., Widick, N. N., & Makani, N. S. (2019). Timely referral to hospice care for oncology patients: A retrospective review. American Journal of Hospice and Palliative Medicine, 36(6), 466-471. Web.

Tobin, J., Rogers, A., Winterburn, I., Tullie, S., Kalyanasundaram, A., Kuhn, I., & Barclay, S. (2021). Hospice care access inequalities: A systematic review and narrative synthesis. BMJ Supportive & Palliative Care. Web.

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NursingBird. (2023, April 4). Late Referrals to Hospice: Clinical (PICOT) Question. Retrieved from


NursingBird. (2023, April 4). Late Referrals to Hospice: Clinical (PICOT) Question.

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"Late Referrals to Hospice: Clinical (PICOT) Question." NursingBird, 4 Apr. 2023,


NursingBird. (2023) 'Late Referrals to Hospice: Clinical (PICOT) Question'. 4 April.


NursingBird. 2023. "Late Referrals to Hospice: Clinical (PICOT) Question." April 4, 2023.

1. NursingBird. "Late Referrals to Hospice: Clinical (PICOT) Question." April 4, 2023.


NursingBird. "Late Referrals to Hospice: Clinical (PICOT) Question." April 4, 2023.