Physicians are educated and trained to cure illness and save lives. The traditional educational model in U.S. medical schools allows for generalist training as well as specialization in specific areas of practice such as pediatrics, geriatrics, or oncology. As the population continues to age, and chronic illnesses challenge cancer diagnoses as the predominant precursor to palliative care, medical students must be educated and trained in the specialties of palliative medicine and end-of-life care. The purpose of this study was to review systematically the empirical evidence related to the ways in which end-of-life care is included in U.S. medical school training.

The present review was undertaken to explore recent evidence in the professional literature pertaining to use of hospice services by African Americans. The article addresses the research methods that have been used to study African American hospice use, obstacles to African American participation in hospice that have been identified, and interventions designed to increase the number of African Americans using hospice services that have been tested. Results indicate that both qualitative and quantitative methods have identified the following key factors that contribute to the underuse of hospice services by members of the African American community: personal or cultural values in conflict with hospice philosophy, lack of awareness of hospice services, concern about burdening family, economic factors, mistrust of the health care system, and expected lack of ethnic minority employees in hospice agencies. Implications for future social work research and practice with terminally ill African Americans and their families include efforts to quantitatively determine whether the identified key factors contribute significantly in the decisions they make regarding end-of-life care. In addition, social work intervention studies are recommended to offer tested interventions designed to increase the use of hospice services that are cost-effective and culturally competent.

The purpose of this column is to discuss innovations and quality improvement efforts in a variety of long-term care settings. These issues are of importance to healthcare professionals as our nation faces the burgeoning growth of the aging population, creating increased demand for improved and innovative long-term care services. This column is coordinated by Marilyn J. Rantz, PhD, RN, FAAN, NHA,