African Americans lag whites in hospice care

NEW YORK (Reuters Health) - African Americans are less likely than whites to receive end-of-life care from a hospice program, particularly for diseases other than cancer, a new study suggests.

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.

In the new study, researchers found that the racial gap is particularly obvious among patients dying of diseases other than cancer.

Among more than 166,000 patients at the largest U.S. hospice provider, researchers found that African-American patients were one-third less likely than whites to have an illness other than cancer.

The findings suggest that closing this "noncancer gap" would go far in reducing racial disparities in overall hospice use, according to Dr. Kimberly S. Johnson and colleagues at Duke University in Durham, North Carolina.

They report the findings in the Journal of Pain and Symptom Management.

Hospice programs were originally developed for the care of terminally ill cancer patients. That has changed since the 1990s, and in the U.S., patients with other life-limiting diseases now make up the majority of hospice enrollees.

Still, many people may remain unaware of the full scope of hospice care, according to Johnson and her colleagues.

In addition, some people see hospice care as "giving up," and studies suggest that African Americans, in particular, have a greater preference for more-aggressive treatments, the researchers note.

This may be particularly true when it comes to diseases other than cancer, they explain. It's harder to predict the life expectancy of someone with advanced heart or lung disease, for example, compared with someone with terminal cancer.

There were "positive changes" seen in the study, according to Johnson's team. Between 1999 and 2003, the percentage of hospice enrollees with non-cancer diagnoses climbed, regardless of race.

However, the racial gap remained steady over time, the researchers found.

More studies, they conclude, are needed to figure out why African Americans have a particularly lower rate of hospice use for diseases other than cancer.

"Targeted efforts to increase hospice use among African Americans with noncancer diagnoses may be important in reducing racial disparities in overall hospice use and improving the quality of care for dying African Americans," they write.

SOURCE: Journal of Pain and Symptom Management, September 2007.