Disparities in End-of-Life Care
For cancer patients at the ends of their lives, hospice care can provide access to comfort measures and extra help. Medicare offers hospice benefits to eligible patients. But not all patients have equal access to this care, research indicates.
In the spring issue of Cancer Today, medical and business journalist Charlotte Huff writes about disparities in end-of-life care affecting U.S. cancer patients.
In 2015, more than half of white Medicare patients who died received hospice care. Just 42 percent of Hispanics, 38 percent of African-Americans, and 35 percent of Asian-Americans enrolled prior to their deaths.
Spiritual beliefs can contribute to reluctance to use hospice care among African-Americans, says Marisette Hasan, a hospice nurse and chief executive officer of the Carolinas Center, a nonprofit trade organization for hospice and palliative care groups in North Carolina and South Carolina. Family members will sometimes say, “‘We’re believing that God is going to heal her, so we don’t want her to get on hospice,’” she says.
Other cultural factors can also influence end-of-life care, says Sandra Sanchez-Reilly, a geriatrician and palliative care physician at the University of Texas Health Science Center at San Antonio. For instance, Latino families may believe they are responsible for caring for their own and may not be receptive to a hospice nurse coming in.
The quality of hospices available may also deter minority patients from enrolling in hospice care. Compared to white patients, black and Hispanic patients receive care in hospices that have lower ratings, suggests a study published in the July 2017 Health Affairs.
Researchers are testing the efficacy of videos and community programs tailored to minority patients to help promote end-of-life discussions. And Medicare is experimenting with a project call the Care Choices Model that allows patients in participating hospices to get hospice services while continuing active treatment—a service that may help patient gain access even if they are reluctant to choose hospice care.