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.
WrightAAZhangBRayA. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665–1673.
6.
FinlayEShreveSCasarettD. Nationwide veterans affairs quality measure for cancer: the family assessment of treatment at end of life. J Clin Oncol. 2008;26(23):3838–3844.
7.
ConnorSRPyensonBFitchKSpenceCIwasakiK. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007;33(3):238–246.
8.
KeyserEAReedBGLoweryWJ. Hospice enrollment for terminally ill patients with gynecologic malignancies: impact on outcomes and interventions. Gynecol Oncol. 2010;118(3):274–277.
9.
BakitasMAhlesTASkallaK. Proxy perspectives regarding end-of-life care for persons with cancer. Cancer. 2008;112(8):1854–1861.
10.
TangSTMcCorkleR. Determinants of congruence between the preferred and actual place of death for terminally ill cancer patients. J Palliat Care. 2003;19(4):230–237.
11.
TaylorDHJrOstermannJVan HoutvenCHTulskyJASteinhauserK. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?Soc Sci Med. 2007;65(7):1466–1478.
12.
EnguidanosSYipJWilberK. Ethnic variation in site of death of older adults dually eligible for Medicaid and Medicare. J Am Geriatr Soc. 2005;53(8):1411–1416.
13.
Van HoutvenCHTaylorDHJrSteinhauserKTulskyJA. Is a home-care network necessary to access the Medicare hospice benefit?J Palliat Med. 2009;12(8):687–694.
14.
HanchateAKronmanACYoung-XuYAshASEmanuelE. Racial and ethnic differences in end-of-life costs: why do minorities cost more than whites?Arch Intern Med. 2009;169(5):493–501.
15.
GreinerKAPereraSAhluwaliaJS. Hospice usage by minorities in the last year of life: results from the National Mortality Followback Survey. J Am Geriatr Soc. 2003;51(7):970–978.
16.
KwakJHaleyWEChiribogaDA. Racial differences in hospice use and in-hospital death among Medicare and Medicaid dual-eligible nursing home residents. Gerontologist. 2008;48(1):32–41.
17.
LocherJLKilgoreMLMorriseyMARitchieCS. Patterns and predictors of home health and hospice use by older adults with cancer. J Am Geriatr Soc. 2006;54(8):1206–1211.
18.
HauptBJ. Characteristics of hospice care discharges and their length of service: United States, 2000. Vital Health Stat. 2003; 13(154):1–36.
19.
CohenLL. Racial/ethnic disparities in hospice care: a systematic review. J Palliat Med. 2008;11(5):763–768.
20.
WinstonCALeshnerPKramerJAllenG. Overcoming barriers to access and utilization of hospice and palliative care services in African-American communities. Omega (Westport). 2004;50(2):151–163.
21.
GordonAK. Deterrents to access and service for blacks and Hispanics: the Medicare hospice benefit, healthcare utilization, and cultural barriers. Hosp J. 1995;10(2):65–83.
22.
CortMA. Cultural mistrust and use of hospice care: challenges and remedies. J Palliat Med. 2004;7(1):63–71.
23.
WashingtonKTBickel-SwensonDStephensN. Barriers to hospice use among African Americans: a systematic review. Health Soc Work. 2008;33(4):267–274.
24.
EarleCCLandrumMBSouzaJMNevilleBAWeeksJCAyanianJZ. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue?J Clin Oncol. 2008;26(23):3860–3866.
25.
MintzerDMZagrabbeK. On how increasing numbers of newer cancer therapies further delay referral to hospice: the increasing palliative care imperative. Am J Hosp Palliat Med. 2007;24(2):126–130.
26.
PayneRMedinaEHamptonJW. Quality of life concerns in patients with breast cancer: evidence for disparity of outcomes and experiences in pain management and palliative care among African-American women. Cancer. 2003;97(1 suppl):311–317.
27.
ConnorSRElwertFSpenceCChristakisNA. Racial disparity in hospice use in the United States in 2002. Palliat Med. 2008;22(3):205–213.
28.
HaasJSEarleCCOravJE. Lower use of hospice by cancer patients who live in minority versus white areas. J Gen Intern Med. 2007;22(3):396–399.
29.
JenkinsTMChapmanKLHarshbargerDSTownsendJS. Hospice use among cancer decedents in Alabama, 2002-2005. Prev Chronic Dis. 2009;6(4):A119.
30.
LackanNAOstirGVFreemanJLMahnkenJDGoodwinJS. Decreasing variation in the use of hospice among older adults with breast, colorectal, lung, and prostate cancer. Med Care. 2004;42(2):116–122.
31.
ShugarmanLRBirdCESchusterCRLynnJ. Age and gender differences in Medicare expenditures and service utilization at the end of life for lung cancer decedents. Women’s Health Issues. 2008;18(3):199–209.
32.
SmithAKEarleCCMcCarthyEP. Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer. J Am Geriatr Soc. 2009;57(1):153–158.
33.
VirnigBAMarshall McBeanAKindSDholakiaR. Hospice use before death: variability across cancer diagnoses. Med Care. 2002;40(1):73–78.
34.
KeatingNLHerrintonLJZaslavskyAMLiuLAyanianJZ. Variations in hospice use among cancer patients. J Natl Cancer Inst. 2006;98(15):1053–1059.
35.
KeatingNLLandrumMBGuadagnoliEWinerEPAyanianJZ. Care in the months before death and hospice enrollment among older women with advanced breast cancer. J Gen Intern Med. 2008;23(1):11–18.
36.
LackanNAFreemanJLGoodwinJS. Hospice use by older women dying with breast cancer between 1991 and 1996. J Palliat Care. 2003;19(1):49–53.
37.
ShugarmanLRBirdCESchusterCRLynnJ. Age and gender differences in Medicare expenditures at the end of life for colo-rectal cancer decedents. J Women’s Health (Larchmt).2007;16(2):214–227.
38.
HwangSSChangVTAlejandroY. Study of hormone refractory prostate cancer: hospital care and palliative care resource use at a VA medical center. Cancer Invest. 2004;22(6):849–857.
39.
McCarthyEPBurnsRBDavisRBPhillipsRS. Barriers to hospice care among older patients dying with lung and colorectal cancer. J Clin Oncol. 2003;21(4):728–735.
40.
JohnsonKSKuchibhatlaMTanisDTulskyJA. Racial differences in the growth of noncancer diagnoses among hospice enrollees. J Pain Symptom Manage. 2007;34(3):286–293.
41.
BradleyCJClementJPLinC. Absence of cancer diagnosis and treatment in elderly Medicaid-insured nursing home residents. J Natl Cancer Inst. 2008;100(1):21–31.
42.
LangKLinesLMLeeDWKornJREarleCCMenzinJ. Trends in healthcare utilization among older Americans with colorectal cancer: a retrospective database analysis. BMC Health Serv Res. 2009;9:227.
43.
McCarthyEPBurnsRBNgo-MetzgerQDavisRBPhillipsRS. Hospice use among Medicare managed care and fee-for-service patients dying with cancer. JAMA. 2003;289(17):2238–2245.
44.
LackanNAOstirGVKuoYFFreemanJL. The association of marital status and hospice use in the USA. Palliat Med. 2005;19(2):160–162.
45.
HanBRemsburgREIwashynaTJ. Differences in hospice use between black and white patients during the period 1992 through 2000. Med Care. 2006;44(8):731–737.
46.
JohnsonKSKuchibhatlaMTanisDTulskyJA. Racial differences in hospice revocation to pursue aggressive care. Arch Intern Med. 2008;168(2):218–224.
47.
RhodesRLTenoJMWelchLC. Access to hospice for African Americans: are they informed about the option of hospice?J Palliat Med. 2006;9(2):268–272.
48.
HuskampHAKeatingNLMalinJL. Discussions with physicians about hospice among patients with metastatic lung cancer. Arch Intern Med. 2009;169(10):954–962.
49.
HwangSSChangVTCogswellJSrinivasSKasimisB. Knowledge and attitudes toward end-of-life care in veterans with symptomatic metastatic cancer. Palliat Support Care. 2003;1(3):221–230.
50.
FishmanJO’DwyerPLuHLHendersonHAschDACasarettDJ. Race, treatment preferences, and hospice enrollment: eligibility criteria may exclude patients with the greatest needs for care. Cancer. 2009;115(3):689–697.
51.
BornWGreinerKASylviaEButlerJAhluwaliaJS. Knowledge, attitudes, and beliefs about end-of-life care among inner-city African Americans and Latinos. J Palliat Med. 2004;7(2):247–256.
52.
JacksonFSchimSMSeeleySGrunowKBakerJ. Barriers to hospice care for African Americans: problems and solutions. J Hosp Palliat Nurs. 2000;2(2):65–72.
53.
JenkinsCLapelleNZapkaJGKurentJE. End-of-life care and African Americans: voices from the community. J Palliat Med. 2005;8(3):585–592.
54.
ReeseDJAhernRENairSO’FaireJDWarrenC. Hospice access and use by African Americans: addressing cultural and institutional barriers through participatory action research. Soc Work. 1999;44(6):549–559.
55.
JohnsonKSKuchibhatlaMTulskyJA. Racial differences in self-reported exposure to information about hospice care. J Palliat Med. 2009;12(10):921–927.
56.
FordDWNietertPJZapkaJZollerJSSilvestriGA. Barriers to hospice enrollment among lung cancer patients: a survey of family members and physicians. Palliat Support Care. 2008;6(4):357–362.
57.
LorenzKARosenfeldKEAschSMEttnerSL. Charity for the dying: who receives unreimbursed hospice care?J Palliat Med. 2003;6(4):585–591.
58.
YancuCNFarmerDFLeahmanD. Barriers to hospice use and palliative care services use by African American adults. Am J Hosp Palliat Care. 27(4):248–253.
59.
CampbellCLMerwinEYanG. Factors that influence the presence of a hospice in a rural community. J Nurs Scholarsh. 2009;41(4):420–428.
60.
LoggersETMaciejewskiPKPaulkE. Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. J Clin Oncol. 2009;27(33):5559–5564.
61.
EarleCCNevilleBALandrumMBAyanianJZBlockSDWeeksJC. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004;22(2):315–321.
62.
JohnsonKSKuchibhatlaMTulskyJA. What explains racial differences in the use of advance directives and attitudes toward hospice care?J Am Geriatr Soc. 2008;56(10):1953–1958.
63.
LudkeRLSmuckerDR. Racial differences in the willingness to use hospice services. J Palliat Med. 2007;10(6):1329–1337.
64.
NeubauerBJHamiltonCL. Racial differences in attitudes toward hospice care. Hosp J. 1990;6(1):37–48.
65.
RosenfeldPDennisJHanenS. Are there racial differences in attitudes toward hospice care?A study of hospice-eligible patients at the Visiting Nurse Service of New York. Am J Hosp Palliat Care. 2007;24(5):408–416.
66.
DuffySAJacksonFCSchimSMRonisDLFowlerKE. Racial/ethnic preferences, sex preferences, and perceived discrimination related to end-of-life care. J Am Geriatr Soc. 2006;54(1):150–157.
67.
CarlsonMDHerrinJDuQ. Hospice characteristics and the disenrollment of patients with cancer. Health Serv Res. 2009;44(6):2004–2021.
68.
CintronAHamelMBDavisRBBurnsRBPhillipsRSMcCarthyEP. Hospitalization of hospice patients with cancer. J Palliat Med. 2003;6(5):757–768.
69.
KapoJMacMoranHCasarettD. “Lost to follow-up”: ethnic disparities in continuity of hospice care at the end of life. J Palliat Med. 2005;8(3):603–608.
70.
RhodesRLTenoJMConnorSR. African American bereaved family members’ perceptions of the quality of hospice care: lessened disparities, but opportunities to improve remain. J Pain Symptom Manage. 2007;34(5):472–479.
71.
CieminsELStuartBGerberRNewmanJBaumanM. An Evaluation of the Advanced Illness Management (AIM) Program: increasing hospice utilization in the San Francisco Bay area. J Palliat Med. 2006;9(6):1401–1411.
72.
McCuistionPO. Increasing minority access to hospice care. Am J Hosp Palliat Care. 1994;11(5):19–21.
73.
ReeseDJ. Proposal for a university-community-hospice partnership to address organizational barriers to cultural competence. Am J Hosp Palliat Care. 2011;28(1):22–26.
