Blacks more apt to leave hospice for treatment

NEW YORK (Reuters Health) - African Americans who enroll in a hospice program near the end of life are more likely than their white counterparts to leave hospice to pursue life-extending therapies, a new study shows.

The goal of hospice care is to make terminally ill patients comfortable at the end of life, offering treatment for pain and other physical and psychological symptoms. Historically, black Americans have been less likely than whites to enter hospice care. The new study, reported in the Archives of Internal Medicine this month, suggests that once enrolled they are more apt to leave than whites.

In the study, Dr. Kimberly S. Johnson of Duke University in Durham, North Carolina, and colleagues analyzed the files of 166,197 African American and white patients cared for by VITAS -- the largest hospice care provider in the U.S.

As expected, most patients died in hospice care. Overall, 2.8 percent of patients left hospice to pursue life-prolonging treatments, and African Americans were much more likely to do so (4.5 percent versus 2.5 percent).

In analyses accounting for multiple potentially influential factors, African American hospice patients were 70 percent more likely than white hospice patients to leave hospice care to seek potentially life-prolonging care unavailable at hospice.

Moreover, in a subgroup of Florida hospice patients who left hospice to pursue aggressive care, almost half (48.4 percent) were still alive 1 year later, the researchers found. Patients who enter hospice are required to have a prognosis of 6 months or less. Survival rates did not differ between blacks and whites who left hospice.

Johnson and colleagues point out that past research has shown that African Americans are more likely than whites to request life-sustaining therapies at the end of life, regardless of their prognosis. "These beliefs and values that emphasize longevity and deny death" clash with the hospice philosophy of care, they note.

It's also been shown that many patients and families know little about the hospice philosophy, which emphasizes care rather than cure. "This lack of information may be even more common among African American patients, who may have less general knowledge of hospice care," the investigators write.

They suggest that "models of health care that couple curative and (supportive) therapies may be more attractive to African American patients and more effective at maximizing continuity throughout life-limiting illness."

SOURCE: Archives of Internal Medicine, January 28, 2008.