A noteworthy finding in our study was the significant delay between diagnosis and the initial center visit, based on data extracted from the health system data repository; this may also influence the time between palliative care referral and death. This number is in agreement with the delay of 2.2 years from onset of symptoms reported by Lamas and colleagues21 and disappointingly also similar to the delay reported 10 years earlier by King and colleagues.22 While we chose to report time from diagnosis rather than time from onset of symptoms, our findings appear consistent with these and other studies,23,24 given the likely interval between onset of symptoms and diagnosis. Thus, time between onset of symptoms, diagnosis, and evaluation at a specialized care center appears essentially unchanged over the past 12 years, although early evaluation has been recommended.3 Although there is no definitive medical treatment, specialty centers offer multiple benefits, including education, participation in research protocols, timely transplant evaluation and referral, access to integrated outpatient palliative care, and optimum strategies for symptom relief and support group participation.9,12,17 While the reasons for persistence of delay are unclear, their impact on patient outcome, timely evaluation for transplant, or referral to palliative care should be further studied. Patients and caregivers may not be willing to accept early palliative care referral despite the benefits, viewing referral as “giving up hope.” Our experience also suggests that the term palliative care, itself, can lead to patient and family reluctance to accept referral. Other terminology (eg, supportive care, quality of life care) may be more acceptable.25 In addition, future studies should evaluate the benefits of early integrated palliative care in patients with IPF.