Use of Role Model Stories to Overcome Barriers to Hospice among African Americans

Abstract

This small pre-post pilot study found that exposure to a hospice brochure containing theoretically driven, culturally parallel, role model stories was effective in improving knowledge of and attitudes toward hospice as well as intentions to enroll a family member or self in hospice care. Further study is needed to determine the impact of using this brochure within a clinical setting.

Unmet Needs of African Americans and Whites at the Time of Palliative Care Consultation

“…5 Efforts to improve palliative care for AAs have largely focused on reducing the gap between AAs and whites in rates of hospice use. [6][7][8][9][10] Studies cite a number of barriers for AAs, including greater preferences for the use of potentially lifeprolonging therapies when prognosis is poor 11,12 and hospice organization-related barriers, including multicultural competence and recruitment of AA clinicians. [13][14][15] As the Medicare Hospice Benefit requires that patients forgo curative treatment and many hospices restrict enrollment of patients who desire costly palliative therapies (eg, blood transfusions, artificial nutrition), hospice may not be congruent with the beliefs and preferences of many AAs.…”

Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?

“…In 2011, 47% of White Medicare beneficiaries used hospice compared to only 35% of African Americans (2). With evidence that hospice enrollment improves end-of-life care, efforts have increased to understand and reduce racial differences in hospice use (3–9). Increasing hospice use among African Americans may help to address documented disparities in pain management, communication, and satisfaction with end-of-life care (10, 11).…”

Interventions to Improve Hospice and Palliative Care Referral: A Systematic Review

“…[29][30][31] It is known that African American and Hispanics are less likely to use hospice services at the end of their lives. 31 Possible barriers to hospice referral in African American populations include lack of awareness, misconceptions regarding hospice being associated with withdrawal of all treatments, mistrust, 32 or a preference for the use of life-prolonging treatment, despite the presence of a poor prognosis 33 This may be considered a sign of respect for their loved ones.…”