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Townsend A, March AL, Kimball J. Can Faith and Hospice Coexist: Is the African American Church the Key to Increased Hospice Utilization for African Americans? J Transcult Nurs 2015; 28:32-39. [PMID: 26297709 DOI: 10.1177/1043659615600764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches (N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community.
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Pan CX, Abraham O, Giron F, LeMarie P, Pollack S. Just ask: hospice familiarity in Asian and Hispanic adults. J Pain Symptom Manage 2015; 49:928-33. [PMID: 25499419 DOI: 10.1016/j.jpainsymman.2014.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 09/26/2014] [Accepted: 10/22/2014] [Indexed: 11/23/2022]
Abstract
CONTEXT Previous research documents the under-utilization of hospice services by minority ethnic groups, but less data exist for Asian and Hispanic Americans. It is unclear whether these low utilization rates are a result of attitudinal or information barriers, or both. OBJECTIVES To examine self-reported familiarity and attitudes toward hospice among Asian and Hispanic groups in ethnically diverse Queens County, NY. METHODS We surveyed diverse adults during health fairs, at senior centers, and church programs directed at ethnic populations. Respondents completed surveys in their preferred language: Spanish, Chinese (Mandarin), and Korean. Analysis of variance was used to compare continuous variables among language groups; Fisher's exact test compared categorical variables. RESULTS A total of 604 community adults were surveyed: 99 Chinese, 349 Korean, 156 Spanish. Respondents were mostly female, average age 53 years. Familiarity with hospice varied significantly among the groups (P < 0.001) and was lower in the Hispanic (16%) and higher in the Chinese (45%) and Korean (56%) groups. Personal experiences with hospice were low (8-16%) in all groups. A majority (75-94%) responded they would share hospice information with loved ones, but the Hispanic group was significantly less likely to do so compared with Chinese and Korean Americans. Between 74 and 95% reported willingness to receive future information about hospice, but the Korean group was significantly less likely to want information. CONCLUSION When surveyed in their preferred language, Asian and Hispanic adults reported variable levels of familiarity with hospice services. Most responded positively to receiving future information and would tell friends and family members about hospice.
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Affiliation(s)
| | - Olga Abraham
- School of Health Sciencs, Touro College, Bay Shore, New York, USA
| | - Fatima Giron
- University of Illinois College of Medicine, Chicago, Illinois, USA
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Cagle JG, Van Dussen DJ, Culler KL, Carrion I, Hong S, Guralnik J, Zimmerman S. Knowledge About Hospice: Exploring Misconceptions, Attitudes, and Preferences for Care. Am J Hosp Palliat Care 2014; 33:27-33. [PMID: 25138649 DOI: 10.1177/1049909114546885] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Poor knowledge and misperceptions about hospice are believed to be common, but there is scant evidence about the public's understanding of hospice. OBJECTIVES To examine hospice knowledge among geographically diverse adults; and describe linkages between knowledge, attitudes and beliefs about hospice care, and demographics. METHODS A small cross-sectional telephone survey of adults living in the contiguous US was conducted using randomly selected numbers (cell phone and landline) and over-sampling of minorities. Measures assessed knowledge (23-item test), attitudes (8-item scale), experiences and preferences related to hospice. RESULTS 123 participants completed surveys (response rate 46%). 106 (86%) had heard about hospice, 65 (54%) of whom had a personal experience with hospice. Participants had an average hospice knowledge test score of 18 (SD = 3.4) indicating moderate knowledge of hospice. A majority of respondents (62%) did not know that hospice cannot provide concurrent cure-oriented care. Misperceptions about eligibility, coverage of hospice, the provision of hospice in nursing homes or to persons who live alone were not uncommon (missed by >20%). Greater knowledge of hospice was associated with more favorable attitudes about the hospice philosophy of care (r = .22, p = .023) and a greater preference for hospice (p = .049). Respondents who were more educated, worked in the medical field, were non-Hispanic White, and had direct experience with hospice were also more likely to be more knowledgeable about hospice. CONCLUSION Despite relatively high hospice awareness and favorability, myths and misperceptions about hospice still abound--and may drive ethnic disparities in end-of-life care. Educational interventions and future study are needed.
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Affiliation(s)
- John G Cagle
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | | | - Krystal L Culler
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Iraida Carrion
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Seokho Hong
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Jack Guralnik
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sheryl Zimmerman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jeong S, Ohr S, Pich J, Saul P, Ho A. 'Planning ahead' among community-dwelling older people from culturally and linguistically diverse background: a cross-sectional survey. J Clin Nurs 2014; 24:244-55. [PMID: 25041247 DOI: 10.1111/jocn.12649] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore preparedness of end-of-life care planning among community-dwelling older persons of culturally and linguistically diverse background. BACKGROUND To improve end-of-life care through advance care planning, the key concept 'Planning ahead' has been promoted in Australia. However, since the introduction of the model in 2008, it is not known whether 'Planning Ahead' practice by older people from culturally and linguistically diverse backgrounds has improved. DESIGN A cross-sectional survey. METHODS A total of 453 community older adults (65+) who attended 17 day care centres in a region were invited to participate in the study. A total of 229 people completed the survey with a response rate of 50·5%. The questions relevant to this study include: (1) awareness of enduring guardian, advance care directive and advance care planning, (2) the preference for substitute decision-makers and (3) the challenges experienced with advance care planning. RESULTS Awareness of advance care planning was low, and completion of advance care directive was very low. 37·5% of Anglo Celtic group had an enduring guardian, compared with 15·5, 24·1 and 13·3% from Mediterranean, Eastern European and Asia/Pacific group, respectively. Children were the most preferred substitute decision-makers more for Asia/Pacific group than Anglo Celtic, Mediterranean and Eastern Europeans. The various difficulties experienced included being time-consuming, difficult to understand terms and forms, and do not know how to do it. CONCLUSION Regardless of cultural and ethnic backgrounds, a low level of 'Planning ahead' practices was apparent because of a lack of understanding of the concept, the forms and the processes involved. The gap identified between the existing legal/ethical frameworks and the preferences of older people as substitute decision-makers adds new knowledge for further discussion. RELEVANCE TO CLINICAL PRACTICE Nursing professionals are provided with an opportunity to improve their practice to meet the needs of older persons and their families in planning ahead for future treatment options.
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Affiliation(s)
- Sarah Jeong
- The School of Nursing & Midwifery, The University of Newcastle, Ourimbah, NSW, Australia
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55
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Carrion IV, Cagle JG, Van Dussen DJ, Culler KL, Hong S. Knowledge About Hospice Care and Beliefs About Pain Management. Am J Hosp Palliat Care 2014; 32:647-53. [DOI: 10.1177/1049909114536023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Context: Among Hispanics, incomplete knowledge about hospice care may explain low rates of utilization and culturally-specific beliefs about pain and pain treatments may contribute to disparities in pain management. Objectives: To compare (1) knowledge and attitudes regarding hospice, (2) and beliefs about pain and pain medication between Hispanics and non-Hispanics. Methods: A cross-sectional phone-based survey of adults living in the contiguous United States was conducted using randomly selected phone numbers with over-sampling for diversity. Measures assessed knowledge (a 23-item test), attitudes (an 8-item scale), experiences, preferences related to hospice and beliefs regarding pain and pain management. Results: 123 individuals participated in the survey, 13% of whom were Hispanic. Hispanics were less likely to have heard of hospice are ( p <. 001) and, among those who had, more likely to have inaccurate information about it ( p = .05). Specifically, Hispanics were more likely to report that only individuals over age 65 are eligible for hospice services, which is incorrect (44% vs. 93% of non-Hispanics; p=.001). Only 67% of Hispanics knew that hospice helps family members as well as the dying person. More Hispanics (43%) than non-Hispanics (9.3%) reported that admitting pain is a sign of weakness ( p < .001). A greater proportion of Hispanic respondents agreed that a good patient does not talk about pain ( p = .07): 38% vs. 18% from non-Hispanics. Conclusion: Despite the increasing knowledge of hospice care among Hispanics, specific information about the scope of services remains limited. Cultural beliefs about pain management, along with inadequate knowledge of the role of pain management at end of life, persist.
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Affiliation(s)
| | - John G. Cagle
- School of Social Work, University of Maryland-Baltimore, Baltimore, MD, USA
| | | | - Krystal L. Culler
- Psychology of Adult Development and Aging Program, University of Akron, Akron, OH, USA
| | - Seokho Hong
- School of Social Work, University of Maryland-Baltimore, Baltimore, MD, USA
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Abstract
Racial and ethnic disparities in health care access and quality are well documented for some minority groups. However, compared to other areas of health care, such as disease prevention, early detection, and curative care, research in disparities in palliative care is limited. Given the rapidly growing population of minority older adults, many of whom will face advanced serious illness, the availability of high-quality palliative care that meets the varied needs of older adults of all races and ethnicities is a priority. This paper reviews existing data on racial and ethnic disparities in use of and quality of palliative care and outlines priorities for future research.
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Affiliation(s)
- Kimberly S Johnson
- 1 Department of Medicine, Division of Geriatrics, Center for the Study of Aging and Human Development, Center for Palliative Care, Duke University , Durham, North Carolina
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57
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Evans BC, Ume E. Psychosocial, cultural, and spiritual health disparities in end-of-life and palliative care: where we are and where we need to go. Nurs Outlook 2013; 60:370-5. [PMID: 23141196 DOI: 10.1016/j.outlook.2012.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/18/2012] [Accepted: 08/20/2012] [Indexed: 12/13/2022]
Abstract
Although health disparities are well documented, the extent to which they affect end-of-life care is unknown. Limited research funding leads to sparse and often contradictory palliative care literature, with few studies on causal mechanisms. This article explores the psychosocial, cultural, and spiritual health disparities existing in palliative and end-of-life care with the goal of identifying future research needs. This article reports efforts to determine knowledge gaps related to health disparities in psychosocial, cultural, and spiritual aspects of end-of-life care in which the authors draw upon recent literature from multiple databases. Although few data are available, studies show that minorities make little use of hospice, often because of lack of knowledge about hospice or palliative care, family-centered cultures, and preferences for more aggressive end-of-life care than hospice allows. The authors conclude that future research should include a search for theoretical and causal mechanisms; prospective longitudinal investigations; diverse patients, conditions, contexts, and settings; methodological diversity and rigor; and interdisciplinary, culturally sensitive interventions.
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Affiliation(s)
- Bronwynne C Evans
- Arizona State University College of Nursing & Health Innovation, Phoenix, AZ 85004, USA.
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58
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Baldwin PK, Wittenberg-Lyles E, Kruse RL, Demiris G, Parker Oliver D. Pain management and the African American hospice caregiver: a case report. Am J Hosp Palliat Care 2012; 30:795-8. [PMID: 23233538 DOI: 10.1177/1049909112469274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paula K Baldwin
- 1Curtis W. and Ann H. Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
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59
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Kumar P, Casarett D, Corcoran A, Desai K, Li Q, Chen J, Langer C, Mao JJ. Utilization of supportive and palliative care services among oncology outpatients at one academic cancer center: determinants of use and barriers to access. J Palliat Med 2012; 15:923-30. [PMID: 22731514 DOI: 10.1089/jpm.2011.0217] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED Abstract Background: Cancer causes significant symptom burden and diminished quality of life. Despite the expansion of supportive and palliative care services (SPCS), little is known about rates of utilization and barriers to access to these services among oncology outpatients. METHODS We performed a cross-sectional survey in three outpatient medical oncology clinics. Patients with a diagnosis of breast, lung, or gastrointestinal (GI) cancer and a Karnofsky score of ≥60 were included. Patients reported their use of SPCS and any perceived barriers. Multivariable logistic regression was used to identify factors associated with SPCS use. RESULTS Among 313 participants, (50.5%) had not used SPCS since cancer diagnosis. The most common services used were nutrition (26.5%), psychiatric/psychological counseling (29.7%), and physical therapy (15.1%). Pain/palliative care and cancer rehabilitation consultations were used by 8.5% and 4.1% of participants, respectively. In multivariate analysis, graduate education was associated with greater SPCS use (adjusted odds ratio [AOR] 2.14, 95% confidence interval [CI] 1.08-4.26) compared with those with high school or less, whereas having lung cancer was associated with less SPCS use (AOR 0.48, 95% CI 0.24-0.96) when compared with those having breast cancer. The biggest reported barriers to using SPCS were a lack of awareness (22.4%) and lack of physician referral (23%). CONCLUSIONS Approximately half of these patients had not accessed SPCS since cancer diagnosis and cite lack of awareness and physician nonreferral as barriers. Further research is needed to understand patients' needs and beliefs regarding SPCS, and how to integrate SPCS into conventional treatments to improve cancer care.
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Affiliation(s)
- Pallavi Kumar
- Division of Geriatric and Palliative Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street / 2 Gates, Philadelphia, PA 19104, USA
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60
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Fishman JM, Ten Have T, Casarett D. Is public communication about end-of-life care helping to inform all? Cancer news coverage in African American versus mainstream media. Cancer 2012; 118:2157-62. [PMID: 21952922 PMCID: PMC4164161 DOI: 10.1002/cncr.26499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/15/2011] [Accepted: 07/20/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Because cancers are a leading cause of death, these diseases receive a great deal of news attention. However, because news media frequently target specific racial or ethnic audiences, some populations may receive different information, and it is unknown whether reporting equally informs all audiences about the options for care at the end of life. This study of news reporting compared "mainstream" (general market) media with African American media, which serves the largest minority group. The specific goal of this study was to determine whether these news media communicate differently about cure-directed cancer treatment and end-of-life alternatives. METHODS This content analysis included 660 cancer news stories from online and print media that targeted either African American or mainstream audiences. The main outcome measures included whether reporting discussed adverse events of cancer treatment, cancer treatment failure, cancer death/dying, and end-of-life palliative or hospice care. RESULTS Unadjusted and adjusted analyses indicated that the news stories in the African American media are less likely than those in mainstream media to discuss each of the topics studied. Comparing the proportions of news stories in mainstream versus African American media, 31.6% versus 13.6% discussed adverse events (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.51-5.66; P = .001); 14.1% versus 4.2% mentioned treatment failure (OR, 3.79; 95% CI, 1.45-9.88; P = .006); and 11.9% versus 3.8% focused on death/dying (OR, 3.42; 95% CI, 1.39-8.38; P = .007). Finally, although very few news stories discussed end-of-life hospice or palliative care, all were found in mainstream media (7/396 vs 0/264). CONCLUSION The African American news media sampled are less likely than mainstream news media to portray negative cancer outcomes and end-of-life care. Given media's segmented audiences, these findings raise concerns that not all audiences are being informed equally well. Because media content is modifiable, there may be opportunities to improve public cancer communication.
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Affiliation(s)
- Jessica M Fishman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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61
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Conner NE. Predictive factors of hospice use among Blacks: applying Andersen's Behavioral Model. Am J Hosp Palliat Care 2011; 29:368-74. [PMID: 22072640 DOI: 10.1177/1049909111425227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this prospective, correlational study was to examine the differential ability of demographic variables, beliefs, and values about end-of-life, spirituality, and social relationships to predict hospice use among blacks. The framework for this study was the Behavioral Model of Health Services Use. Data were collected from 104 terminally ill black men and women recruited from 6 inpatient and outpatient settings. Only 34% of the individuals participated in hospice services. Chi-square, sequential, and stepwise logistic regressions revealed that the best predictive model consisted of presence of a caregiver, having a religious affiliation, and male gender. Together these factors predicted 13.7% to 19% of hospice use among blacks. Health care providers can use these findings in planning care for patients early in their disease trajectory.
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Affiliation(s)
- Norma E Conner
- University of Central Florida, College of Nursing, Orlando, FL 32826, USA.
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62
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Ramey SJ, Chin SH. Disparity in hospice utilization by African American patients with cancer. Am J Hosp Palliat Care 2011; 29:346-54. [PMID: 22025746 DOI: 10.1177/1049909111423804] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with cancer represent the largest group of hospice users, making this population critically important in hospice research studies. Despite the potential benefits of hospice, many studies have noted lower levels of utilization among African Americans. The goal of this literature review was to determine whether this disparity exists within this population of patients with cancer. The largest studies focusing on multiple cancers found lower hospice use among African American patients with cancer. Disparities also existed after entry into hospice. Age, gender, geographic location, preference for aggressive care, and knowledge of hospice influenced hospice use by these patients. Since African American patients with cancer evidently use hospice at a lower rate, future studies should explore potential barriers to participation by this patient population and methods to remove these obstacles.
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Affiliation(s)
- Stephen J Ramey
- Department of Medicine, Division of Hematology and Oncology, Charleston, SC, USA
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63
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Johnson KS, Kuchibhatla M, Tulsky JA. Racial differences in location before hospice enrollment and association with hospice length of stay. J Am Geriatr Soc 2011; 59:732-7. [PMID: 21410443 DOI: 10.1111/j.1532-5415.2011.03326.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
African Americans are less likely than Whites to enroll in hospice. In addition, patients are often referred to hospice very close to death, when they may not have time to take advantage of the full range of hospice services. Understanding how race and location before hospice enrollment are related to hospice length of stay (LOS) may inform the development of interventions to increase timely access to hospice care. Using data from a national hospice provider, African Americans and Whites admitted to routine home hospice care in a private residence between January 1, 2000, and December 31, 2003, were identified. Logistic regression was used to examine the association between race and hospice preadmission location (hospital vs other locations) and preadmission location and hospice LOS (≤7 days vs >7 days) after adjusting for demographic and hospice use variables. Of 43,869 enrollees, 15.3% were African American. One to 2 days before hospice enrollment, African Americans were more likely than Whites to be in the hospital than in all other locations (48.6% vs 32.3%, P<.001; adjusted odds ratio=1.83, 95% confidence interval=1.73-1.95). Regardless of race, those whose preadmission location was the hospital were more likely than those from other locations to die 7 days or less after hospice enrollment. Initiatives to improve end-of-life care should focus on increasing timely access to hospice referrals in settings outside of the hospital. Future research should examine whether racial differences in hospice preadmission location reflect differences in preferences for care or disparities in timely access to hospice referrals in non-acute care settings.
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Ache KA, Shannon RP, Heckman MG, Diehl NN, Willis FB. A preliminary study comparing attitudes toward hospice referral between African American and white American primary care physicians. J Palliat Med 2011; 14:542-7. [PMID: 21294674 DOI: 10.1089/jpm.2010.0426] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED End-of-life (EOL) decision making is an integral component of high-quality health care. Factors influencing individual primary care physicians (PCPs) can affect their perspectives and referral preferences for EOL care. Numerous barriers have been cited, including patient and family readiness, physicians' comfort with discussing death, and the pursuit of a cure. This study explores another barrier by examining physician ethnicity and comparing the attitudes toward hospice referral between African American and white American primary care providers (PCPs). Training PCPs to efficiently transition from a curative model of care to a palliative model of care has the potential to increase the level of appropriate EOL care, increase hospice referral, and enhance patient and provider satisfaction; it is also fiscally prudent. This preliminary study aims to compare attitudes toward hospice referral and physicians' personal experiences with hospice between African American and white American PCPs. METHODS The survey tool was developed by PCPs at the Mayo Clinic Florida after a full literature review and consultation with hospice physicians, oncology specialists, and primary care colleagues from the residency programs at Mayo Minnesota and Mayo Arizona, with input from the Mayo Survey Office, and distributed to all physicians and residents in the departments of Family Medicine at via Mayo's intranet; Mayo's Midwest Regional Practices (245 physicians) received the survey via standard mail. The survey consisted of 17 questions regarding attitudes toward hospice referral and the one question regarding physicians' personal experience with hospice. The final sample size consisted of 167 white American physicians and 46 African American physicians. Responses were compared using a Wilcoxon rank sum test. P values ≤ 0.05 were considered statistically significant. All statistical analyses were performed using the SAS software package (SAS Institute, Cary, North Carolina). RESULTS The distributions of physician age, specialty, board certification, and years practicing medicine were similar between African American and white American physicians, while male gender was more common in white American physicians than African American physicians. Statistically significant differences in attitudes toward hospice between African American and white American physicians were observed for five of the 17 survey questions. There was a dramatic difference in the distribution of patient race between African American and white American physicians, raising the possibility that any differences between white American and African American physicians could be attributed to patient race, rather than physician race. Due to survey limits, larger studies involving more African American physicians are needed to address this topic. CONCLUSION The results of our preliminary study suggest that certain attitudes toward hospice referral may differ between African American and white American PCPs. If validated, further insight into this issue could lead to educational programs for PCPs that correct misperceptions.
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Affiliation(s)
- Kevin A Ache
- Palliative Medicine Fellowship Program, Department of Family Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA.
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65
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Enguidanos S, Kogan AC, Lorenz K, Taylor G. Use of Role Model Stories to Overcome Barriers to Hospice among African Americans. J Palliat Med 2011; 14:161-8. [DOI: 10.1089/jpm.2010.0380] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Susan Enguidanos
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, California
- Partners in Care Foundation, San Fernando, California
| | | | - Karl Lorenz
- VA Greater Los Angeles, Los Angeles, California
| | - George Taylor
- Partners in Care Foundation, San Fernando, California
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Abstract
ABSTRACTIncreased life expectancy has strengthened the association between old age and death, with significant implications for gerontology and for the generation of knowledge through research. The global rise in chronic disease has had a significant impact on the duration and shape of dying trajectories in old age and their variations. This development poses ethical and methodological challenges for researchers, not least because it is often difficult to establish whether an older person is ‘dying from’ as opposed to ‘living with’ one or more diseases. This paper reports a comprehensive literature review of empirical research on the end-of-life in old age, and has two inter-related themes. It explores the social and cultural contexts of death and critically analyses the methods and ethical approaches adopted by researchers. Cross-cultural studies and studies in which cultural factors were of prime interest were selected with a view to examining the concept of a ‘good death’ in old age. The paper discusses the evidence of cultural similarities and differences and the impact of social and cultural change on ideas concerning a good death. It identifies contemporary influences and pressures on end-of-life care for older people and discusses the significance of communication and the roles of families and service providers. The paper concludes by identifying substantive and methodological lessons for researchers in gerontology and suggests ways in which the impact of research might be enhanced.
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68
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Carlson MDA, Bradley EH, Du Q, Morrison RS. Geographic access to hospice in the United States. J Palliat Med 2010; 13:1331-8. [PMID: 20979524 DOI: 10.1089/jpm.2010.0209] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite a 41% increase in the number of hospices since 2000, more than 60% of Americans die without hospice care. Given that hospice care is predominantly home based, proximity to a hospice is important in ensuring access to hospice services. We estimated the proportion of the population living in communities within 30 and 60 minutes driving time of a hospice. METHODS We conducted a cross-sectional study of geographic access to U.S. hospices using the 2008 Medicare Provider of Services data, U.S. Census data, and ArcGIS software. We used multivariate logistic regression to identify gaps in hospice availability by community characteristics. RESULTS As of 2008, 88% of the population lived in communities within 30 minutes and 98% lived in communities within 60 minutes of a hospice. Mean time to the nearest hospice was 15 minutes and the range was 0 to 403 minutes. Community characteristics independently associated with greater geographic access to hospice included higher population density, higher median income, higher educational attainment, higher percentage of black residents, and the state not having a Certificate of Need policy. The percentage of each state's population living in communities more than 30 minutes from a hospice ranged from 0% to 48%. CONCLUSIONS Recent growth in the hospice industry has resulted in widespread geographic access to hospice care in the United States, although state and community level variation exists. Future research regarding variation and disparities in hospice use should focus on barriers other than geographic proximity to a hospice.
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Affiliation(s)
- Melissa D A Carlson
- Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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69
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Currow DC. Even in death …. J Palliat Med 2009; 12:983-4. [DOI: 10.1089/jpm.2009.9944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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