Although hospice care has been available in the United States for over 25 years , the trend of late terminal access persists . Quality assessments and interventions that will continue through a year of bereavement are based on early interactions and the formation of caring and trusting bonds . A qualitative research study was conducted to identify and describe barriers to timely access as perceived by those involved in hospice care: caregivers , hospice staff and volunteers , and referring physicians . Major findings include persistent knowledge deficits including misconceptions and lack of awareness of components and skill associated with hospice care: reluctance to disclose , discuss , or acknowledge patient terminality , and access of hospice care being perceived as giving up on the patient.