The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #54038

Kimberly S. Reynolds, MPA, School of Public Health, Dept. of Health Behavior and Health Education, University of North Carolina at Chapel Hill, CB # 7440, Chapel Hill, NC 27599-7440, 919-843-8078, kimberly_reynolds@unc.edu

Background: Compared to whites, black Americans are more likely to have untreated pain at the end of life, report less satisfaction with health care providers, and are less likely to receive high-quality palliative care services: Only 8% of hospice enrollees in this country are black - 50% less than the percentage of African-Americans in the population. Objective: This study's aim was to increase understanding of cultural variations in use of hospice. Methods: We conducted interviews and focus groups with 80 family members of recently deceased African-American and white individuals. Study participants were divided equally among 4 categories: (1) black caregivers whose dying relatives used hospice, (2) white caregivers whose dying relatives used hospice, (3) black caregivers whose family members did not use hospice, and (4) white caregivers whose family members did not use hospice. Results: Decisions about end-of-life care are influenced by a broad range of personal attributes and cultural values, including trust in the health care system and in individual health care providers, religious beliefs, opinions about the role of family and friends in caregiving, availability of social support systems, and attitudes about pain and suffering. Families that use and do not use hospice services tend to express disparate views on these topics. African-American families that do not use hospice describe particularly poor communication with health care providers. Conclusions: Improved end-of-life care is yet another area that needs to be addressed systematically and comprehensively as part of the public health community's goal of eliminating racial disparities in health.

Learning Objectives:

• Describe differences in types of health care services received near the end of life by African-American and Caucasian populations.
• Discuss personal attributes and cultural values that can influence decisionmaking about end-of-life care.
• Identify ways in which health care providers and health care systems could improve palliative care services.

Keywords: African American, Health Disparities

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.