Racial differences in the willingness to use hospice services

Objective: This study assesses whether racial differences exist in the willingness to use hospice services in the future among black and white adults and potential factors that may contribute to such differences. Methods: Data were collected from the City of Cincinnati component of the Greater Cincinnati Survey. A total of 510 random-digit-dialed telephone interviews were completed, with 473 adults included in the analyses (220 blacks, 253 whites). Results: Relative to whites, blacks were significantly less likely to consider using hospice if they were near the end of life because of a terminal illness and less likely to do so even if their doctor strongly recommended its use. This reluctance was related to their prior exposure to hospice as well as their trust in their doctor to make the right end-of-life care decisions. Like whites, blacks who had a positive prior exposure to hospice were more willing to consider using hospice than those who have not been exposed to hospice, but only for those blacks who trust their doctor. For blacks who do not trust their doctor, those with prior hospice exposure, regardless of their level of satisfaction, were less willing to consider hospice than those without prior exposure. Conclusions: Efforts to increase utilization of hospice services among blacks requires greater insight into the experiences that they have with hospice services for their family members and friends as well as their level of trust in their physician's decision making about end-of-life care.