Access to hospice for African Americans: Are they informed about the option of hospice?

Objective: To examine whether African Americans are informed about hospice services, and to examine demographic or disease factors that may influence receipt of information about hospice. Design: Retrospective cohort study. Setting: Twenty-two states that accounted for nearly 70% of deaths in the United States in 2000. Measurements: A mortality follow-back survey was conducted. Based on sampled death certificates from 22 states, informants listed on the death certificates were contacted by telephone regarding the decedent's dying experience. Among those persons not receiving hospice services, the respondents were asked if hospice was presented as an option for care at the end of life. Results: Of 1578 interviews, 111 decedents were non-Hispanic, African Americans (average age, 71.5 years; 56% female). Of those, 32 (30.3%) of the decedents received hospice services, while 77 (68.5%) did not. Slightly more than half of African Americans (60; 53.8%) were not informed about hospice services and 12 (8.9%) were informed but did not enroll. Cancer sufferers were more likely to be counseled about hospice (p = 0.001). Conclusion: Slightly more than half of African Americans were not informed about hospice services, and of those who were informed, cancer was the leading cause of death. Information about hospice should be provided to patients regardless of diagnosis, and dissemination of information should be done aggressively in the African American community in an effort to make hospice a viable option for end-of-life care.