Minority underutilization of hospice care has been well-documented; however, explanations addressing disparities have failed to examine the scope of factors in operation. Drawing from previous health care access models, a framework is proposed in which access to end-of-life care results from an interaction between patient-level, system-level, and societal-level barriers with provider-level mediators. The proposed framework introduces an innovative mediating factor missing in previous models, provider personal characteristics, to better explain care access disparities. This article offers a synthesis of previous research and proposes a framework that is useful to researchers and clinicians working with minorities at end of life.

To the authors' knowledge, this is the first study to follow IPC patient pain after hospital discharge. Findings support IPC teams' effectiveness in managing pain during hospitalization but suggest a lack of continuity in pain management following discharge. Research exploring IPC patient post-discharge transition experiences will likely improve understanding of post-discharge pain outcomes.

Studies have documented high levels of pain in hospitalized individuals at the end of life, with minorities reporting higher levels of pain than whites. In response, inpatient palliative care (IPC) teams have grown rapidly to improve care of seriously ill individuals. Although research indicates that IPC teams effectively reduce and maintain control of pain, racial and ethnic differences in pain following IPC consultation remain unclear. This study investigated racial and ethnic pain differences after an IPC intervention in 385 seriously ill white, black, and Latino individuals aged 65 and older. Using the 11-point Numeric Rating Scale for pain, individuals were asked to rate their pain intensity at four points during hospitalization (before IPC consultation, 2 and 24 hours after the consultation, and at hospital discharge). Results indicate that whites (F1.657, 173.998 = 16.528, P < .001), blacks (F1.800, 95.410 = 7.103, P = .002), and Latinos (F1.388, 73.584 = 10.902, P < .001) all experienced significant reductions in pain after the intervention. Adjusted multivariate models testing between-group racial and ethnic differences revealed that Latinos were 62% more likely than whites to report experiencing pain at hospital discharge (relative risk = 0.38, 95% confidence interval = 0.15-0.97). Regardless of race or ethnicity, IPC effectively reduces and controls pain after consultation. Despite pain decreases, Latinos remain more likely than whites to report pain at follow-up. Further research is needed to determine the mechanisms in operation and to better understand and address the needs of this population.