Racial Differences in the Willingness to Use Hospice Services

Objective: The study objective was to examine factors that influence African American (AA) family members' end-of-life care decision outcomes for a relative who recently died from serious illness. Methods: A cross-sectional descriptive study design was used. Binary logistic and linear regressions were used to identify factors associated with decision regret and decisional conflict. Forty-nine bereaved AA family members of AA decedents with serious illness who died two to six months prior to enrollment were recruited from the palliative care program in a safety net hospital and a metropolitan church in the Midwest. Measurements used were the Decisional Conflict, Decision Regret, Beliefs and Values, and Quality of Communication scales. Results: Family members who reported higher quality of communication with health care providers had lower decisional conflict. Family members of decedents who received comfort-focused care (CFC) had significantly less decision regret than family members of those who received life-prolonging treatment (LPT). Family members who reported stronger beliefs and values had higher quality of communication with providers and lower decisional conflict. Conclusions: This research adds to a small body of literature on correlates of end-of-life decision outcomes among AAs. Although AAs' preference for aggressive end-of-life care is well-documented, we found that receipt of CFC was associated with less decision regret. To reduce decisional conflict and decision regret at the end of life, future studies should identify strategies to improve family member-provider communication, while considering relevant family member and decedent characteristics.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

End-of-Life Decision Making and Communication of Bereaved Family Members of African Americans with Serious Illness

Smith-Howell

Hickman

Meghani

et al. 2016

“…[1][2][3][4][5][6][7] Differences in perceptions hospice quality have also been identified. In a prior study of the 2005 Family Evaluation of Hospice Care (FEHC) Survey, bereaved family members of African American (AA) patients were more likely to have one or more concerns along certain patient and family-centered domains of care, including pain management, treatment of dyspnea, and provision of emotional support.…”

Section: Introductionmentioning

confidence: 99%

African American Bereaved Family Members' Perceptions of Hospice Quality: Do Hospices with High Proportions of African Americans Do Better?

Rhodes

Liu

Halm

2012

Background: Research suggests that racial differences in end-of-life care persist even among patients enrolled in hospice.Objective: The objective of the study was to examine the association between bereaved family members' satisfaction with hospice services and the proportion of African American (AA) patients in hospice. Methods: The 2007 and 2008 Family Evaluation of Hospice Care (FEHC) Survey examined family members' perceptions of the quality of care on several dimensions including: unmet need for pain, dyspnea, and emotional support; being informed about the patient's condition and what to expect as the patient was dying; being informed about medications and treatments for symptoms; coordination of care; and overall satisfaction with care. We examined the association between family members' perception along each domain and the proportion of AAs served by hospices surveyed. Results: Of the 11,892 AA decedents in 678 hospice programs, 53.7% were female. The leading cause of death was cancer (51.6%). On univariate analysis, family members of decedents who died in hospices that had higher proportions of AAs were less likely to have concerns about unmet pain needs (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.72-0.98), more likely to have concerns about coordination of care (1.28, 1.17-1.40), and less likely to perceive care as excellent or very good (0.73, 0.63-0.84). Coordination-of-care concerns and lower overall rating of care persisted in multivariable analyses. There were no other significant associations between family perceptions and proportions of AAs in hospice. Conclusions: Among hospices with higher proportions of AAs, family members have more concerns about coordination of care and have lower overall perceptions of quality.

“…21 This recommendation is especially important for hospice providers, since lack of knowledge of hospice has been cited as a barrier to hospice use for African Americans. 9,12,13 In this study the church was the most commonly identified partner for community education and outreach. This is not surprising, since African Americans report greater religious commitment and more often attend religious services than whites.…”

Section: Discussionmentioning

confidence: 92%

“…[1][2][3][4][5][6][7][8] The most commonly cited barriers to hospice use for African Americans include preferences for life-sustaining therapies, lack of knowledge about hospice, mistrust of the health care system, and spiritual beliefs. [9][10][11][12][13][14] Experts and national organizations have identified a role for individual hospice providers in addressing some of these barriers. Recommendations include expanding education and outreach, partnering with African American community organizations such as churches, and employing African American staff.…”

Section: Introductionmentioning

confidence: 99%

What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area?

JohnsonKimberly

PayneRichard

KuchibhatlaMaragatha

2016

Background: Experts and national organizations recommend that hospices work to increase service to African Americans, a group historically underrepresented in hospice. Objective: The study objective was to describe strategies among hospices in North and South Carolina to increase service to African Americans and identify hospice characteristics associated with these efforts. Methods: The study was a cross-sectional survey using investigator-developed scales to measure frequency of community education/outreach, directed marketing, efforts to recruit African American staff, cultural sensitivity training, and goals to increase service to African Americans. We used nonparametric Wilcoxon tests to compare mean scale scores by sample characteristics. Results: Of 118 eligible hospices, 79 (67%) completed the survey. Over 80% were at least somewhat concerned about the low proportion of African Americans they served, and 78.5% had set goals to increase service to African Americans. Most were engaged in community education/outreach, with 92.4% reporting outreach to churches, 76.0% to social services organizations, 40.5% to businesses, 35.4% to civic groups, and over half to health care providers; 48.0% reported directed marketing via newspaper and 40.5% via radio. The vast majority reported efforts to recruit African American staff, most often registered nurses (63.75%). Nearly 90% offered cultural sensitivity training to staff. The frequency of strategies to increase service to African Americans did not vary by hospice characteristics, such as profit status, size, or vertical integration, but was greater among hospices that had set goals to increase service to African Americans. Conclusions: Many hospices are engaged in efforts to increase service to African Americans. Future research should determine which strategies are most effective.