“Although most patients do ultimately talk about some end-of-life topics before they die, the vast majority of these conversations happen during acute care hospital stays and at the end of life,” Dr. Nancy Keating, the study’s senior author, said. Keating is an associate professor at Harvard Medical School in Boston. The goal of so-called palliative care is to control pain and other symptoms and to make sure patients and their families are supported emotionally. Hospice care, in particular, is palliative care for patients who are in their last months of life. Many guidelines recommend doctors discuss hospice with patients who are expected to live for less than a year. But Keating and her colleagues write in a research letter published in JAMA Internal Medicine that those conversations are often delayed. For the new report, the researchers used data from 4,368 U.S. doctors who took part in a study that looked at variations in cancer care across the U.S. Researchers asked doctors about their preferences for their own end-of-life care. They also asked them when they would discuss hospice with a hypothetical patient with cancer who was expected to live for another four to six months and currently didn’t have any symptoms. About 65 percent of doctors strongly agreed they would enroll in hospice care if they were terminally ill. Another 21 percent somewhat agreed they would enroll.