Racial/ethnic minorities tend to underutilize hospice services. Guided by Andersen behavioral health model, the purpose of this study was to explore the predictors of the willingness to use hospice services in racially/ethnically diverse older men and women. Data were drawn from the Survey of Older Floridians: 504 non-Hispanic whites, 360 African Americans, 328 Cuban Americans, and 241 non-Cuban Hispanics. In each group, logistic regression models of the willingness to use hospice were estimated. A greater likelihood of willingness was observed among younger non-Hispanic whites and among African Americans with fewer functional disabilities. In non-Cuban Hispanics, English proficiency increased the willingness by 3.1 times. Findings of the study identified group-specific factors contributing to the willingness to use hospice services and hold implications for tailored intervention programs.
ParkNSCarrionIVLeeBSDobbsDShinHJBeckerMA. The role of race and ethnicity in predicting length of hospice care among older adults. J Palliat Med. 2012;15(2):149–153.
5.
Ngo-MetzgerQPhillipsRSMcCarthyEP. Ethnic disparities in hospice use among Asian-American and Pacific Islander patients dying with cancer. J Am Geriatr Soc. 2008;56(1):139–144.
6.
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.
7.
CohenLL. Racial/ethnic disparities in hospice care: a systematic review. J Palliat Med. 2008;11(5):763–768.
8.
CarrionIVParkNSLeeBS. Hospice use among African Americans, Asians, Hispanics, and Whites: implications for practice. Am J Hosp Palliat Care. 2012;29(2):116–121.
9.
BakerME. Economic, political and ethnic influences on end-of-life decision-making: a decade in review. J Health Soc Policy. 2002;14(3):27–39.
10.
BosmaHAplandLKazanjianA. Review: Cultural conceptualizations of hospice palliative care: more similarities than differences. Palliat Med. 2010;24(5):510–522.
11.
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.
12.
CarrionIV. When do Latinos use hospice services? Studying the utilization of hospice services by Hispanics/Latinos. Social Work in Health Care. 2010;49(3):197–210.
13.
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.
14.
HanBRemsburgREIwashynaTJ. Differences in hospice use between black and white patients during the period 1992 through 2000. Medical Care. 2006;44(8):731–737.
15.
Cruz-OliverDMTalamantesMSanchez-ReillyS. What evidence is available on end-of-life (EOL) care and Latino elders? A literature review. Am J Hosp Palliat Care. 2014;31(1):87–97.
16.
ColónM. Hospice and Latinos: a review of the literature. J Soc Work End Life Palliat Care. 2005;1(2):27–43.
17.
ConnorSElwertFSpenceCChristakisN. Racial disparity in hospice use in the United States in 2002. Palliat Med. 2008;22(3):205–213.
18.
JohnsonKS. Racial and ethnic disparities in palliative care. J Palliat Med. 2013;16(11):1329–1334.
19.
NeubauerBJHamiltonCL. Racial differences in attitudes toward hospice care. Hosp J. 1990;6(1):37–48.
20.
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.
21.
CarrionIVCagleJGVan DussenDJCullerKLHongS. Knowledge about hospice care and beliefs about pain management: exploring differences between Hispanics and non-Hispanics[published online June 5, 2014]. Am J Hosp Palliat Med. 2014.
22.
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 Med. 2007;24(5):408–416.
23.
LudkeRLSmuckerDR. Racial differences in the willingness to use hospice services. J Palliat Med. 2007;10(6):1329–1337.
24.
CortMA. Cultural mistrust and use of hospice care: challenges and remedies. J Palliat Med. 2004;7(1):63–71.
25.
ArmstrongKRavenellKLMcMurphySPuttM. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283–1289.
26.
ColónM. Acculturation and attitudes of Latinos toward hospice. J Soc Work End Life Palliat Care. 2012;8(3):229–248.
27.
SelskyCKrelingBLutaG. Hospice knowledge and intentions among Latinos using safety-net clinics. J Palliat Med. 2012;15(9):984–990.
28.
Paasche-OrlowMParkerRGazmararianJNielsen-BohlmanLRuddR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20(2):175–184.
29.
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.
AndersenRMNewmanJF. Societal and individual determinants of medical care utilization in the United States. Milbank Q. 2005;83(4):1–28.
32.
AndersenRM. Revisiting the behavioral model and access to medical care: does it matter?J Health Soc Behav. 1995;36(1):1–10.
33.
JangYChiribogaDAKimGPhillipsK. Depressive symptoms in four racial and ethnic groups: the Survey of Older Floridians (SOF). Res Aging. 2008;30(4):488–502.
34.
ZayacHSalmonJRChiribogaDA. Florida’s Minority Elders: An Assessment of Physical, Mental Health, and Long-Term Care Service Needs. Tampa, FL: Florida Policy Exchange Center on Aging; 2005.
35.
MarkidesKS. Hispanic Established Populations for the Epidemiologic Studies of the Elderly, 1993-1994: [Arizona, California, Colorado, New Mexico, and Texas]. Ann Arbor, MI: Inter-University Consortium for Political and Social Research (ICPSR) [distributor]; 2009.
36.
National health and nutrition examination survey. Centers for Disease Control and Prevention; 2002.
37.
de la IglesiaJMDueñas HerreroROnís VilchesMCAguado TabernéCAlbert ColomerCLuque LuqueR. Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores de 65 años. Med Clín. 2001;117(4):129–134.
38.
PfeifferE. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23(10):433–441.
39.
KatzS. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983;31(12):721–727.
40.
LawtonMPBrodyEM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3 part 1):179–186.
41.
PandyaCMcHughMBatalovaJ. Limited English Proficient Individuals in the United States: Number, Share, Growth, and Linguistic Diversity. Washington, DC: Migration Policy Institute; 2011.
42.
HaasJSEarleCCOravJE. Lower use of hospice by cancer patients who live in minority versus white areas. J Gen Intern Med. 2007;22(3):396–399.
43.
HansenBRHodgsonNAGitlinLN. It’s a matter of trust: Older African Americans speak about their health care encounters [published online February 9, 2015]. J Appl Gerontol. 2015.
44.
PeekMEGorawara-BhatRQuinnMTOdoms-YoungAWilsonSCChinMH. Patient trust in physicians and shared decision-making among African-Americans With diabetes. Health Commun. 2012;28(6):616–623.
45.
RussellERobinsonDZThompsonNPerrymanJArriolaKJ. Distrust in the healthcare system and organ donation intentions among African Americans. J Commun Health. 2012;37(1):40–47.
46.
JangYChiribogaDAAllenJYKwakJHaleyWE. Willingness of older Korean-American adults to use hospice. J Am Geriatr Soc. 2010;58(2):352–356.
47.
SegalDLCoolidgeFLMincicMSO’RileyA. Beliefs about mental illness and willingness to seek help: a cross-sectional study. Aging Ment Health. 2005;9(4):363–367.
48.
McCarthyEPBurnsRBNgo-MetzgerQDavisRBPhillipsRS. Hospice use among Medicare managed care and fee-for-service patients dying with cancer. JAMA. 2003;289(17):2238–2245.
49.
HochhausenLPerryDLeH-N. Neighborhood context and acculturation among Central American immigrants. J Immigr Minor Health. 2010;12(5):806–809.
50.
CarrionIBullockK. A case of Hispanics and hospice care. Int J Hum Soc Sci. 2012;2(4):9–16.
51.
GelfandDEBalcazarHParzuchowskiJLenoxS. Issues in hospice utilization by Mexicans. J Appl Gerontol. 2004;23(1):3–19.
52.
KirkendallAHollandJMKeeneJRLunaN. Evaluation of hospice care by family members of Hispanic and non-Hispanic patients. Am J Hosp Palliat Med. 2015;32(3):313–321.
53.
LoPrestiMADementFGoldHT. End-of-life care for people with cancer from ethnic minority groups: a systematic review[published online December 29, 2014]. Am J Hosp Palliat Med. 2014.
54.
SpruillADMayerDHamiltonJB. Barriers in hospice use among African Americans with cancer. J Hosp Palliat Nurs. 2013;15(3):136–144.
55.
BalboniTABalboniMEnzingerAC. Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. JAMA Intern Med. 2013;173(12):1109–1117.
