In 2021, CAPC’s Project Equity workgroup conducted a comprehensive literature review to understand what is known about disparities in health care experiences and quality of life for Black people living with serious illness, and their families. This is the first time such a literature review has taken place. The Center to Advance Palliative Care (CAPC) has now released the key findings.

The review included peer-reviewed journal articles from the following sources: PubMed, Scopus, and recommendations from the initiative’s steering committee members. Since “serious illness” was the overarching theme, research on various diseases fell within that umbrella, including cancer, heart disease, dementia, end-stage renal disease, and HIV. The inclusion of a study in these key findings does not imply that CAPC endorses or recommends the article. Please refer to the cited articles for more information on their methodology.

Last updated August 2021

Key Findings

  • Generally, Black patients receive less pain assessment[1] and treatment[2],[3],[4] than their White peers over the course of their serious illnesses.

  • In a 2017 study, researchers found that Black patients were more likely to report pain of any severity than White patients.[5]

  • Other research, however, found no difference in opioid use between racial groups (of stage IV breast cancer patients).[6]

  • Black family members were less likely to have concerns about unmet pain needs when served by hospices with higher proportions of Black patients.[7]

  • Potential barriers to pain management identified for Black cancer patients include patient fear of addiction, a dislike for taking pills, concern about opioid-induced constipation, and the belief that doctors should focus more on curing illness than on pain control.[8]

  • Some participants in a small, qualitative study of Black patients with Sickle Cell Disease reported that they had been accused of pill-seeking behavior.[9]
  • Various studies found that medications used for symptom management (such as benzodiazepines and bowel regimens for opioid-induced constipation), were used less for Black patients.[1],[2],[3],[6]

  • A study of data contained in the Global Palliative Care Quality Alliance’s QDACT Registry reported that Black patients were more likely to have a Palliative Performance Score (PPS) of ≤ 30 at the time of palliative care consultation, illustrating more unmet needs.[5]
  • Qualitative studies found that Black patients identified a “lack of communication” and the absence of positive relationships with their doctors as negative aspects of their care.[9],[10]

  • In a study of the communication skills of hospital-based physicians, lower-quality nonverbal communication (e.g., open body language, physical distance) occurred when interacting with Black patients compared to White patients.[11]

  • In a small study of bereaved Black family members of Black patients, the participants rated the quality of end-of-life communication lower than that for general communication with their health care providers. Lower scores in communication quality were also associated with higher feelings of decisional conflict.[12]

Note: Studies referenced in this section used either the identification of a palliative care consult in the medical record or the presence of the ICD-9 or ICD-10 code for a “palliative care encounter.” Differences in the methodology used to identify palliative care interventions may contribute to the diversity of the results.

  • Across different disease processes, studies have found that Black patients are less likely to receive palliative care than White patients.[13],[14],[15] In one study, none of the Black patients included in their sample of patients with non-traumatic intracranial hemorrhage received a palliative care consult even though their Glasgow Coma Scale (GCS) scores at hospital admission were significantly worse than those of White or Asian patients. The authors wondered if this finding could be due to practitioner bias or patient preference.[16]

  • A 2019 study found that patients treated by hospitals that serve predominantly non-White patients were less likely to receive palliative care (defined as the patient’s goals of treatment being palliative in nature rather than curative), regardless of their race or ethnicity, when compared to patients treated at hospitals that serve predominantly White patients.[13]

  • Other studies, however, found that Black patients were just as likely or more likely to receive a palliative care consult.[2],[17],[18],[19]
  • Several studies found that Black patients, across various serious illness diagnoses, including cancer and severe acute brain injury, were less likely to be referred to hospice[20] or use hospice,[4],[21],[22],[23],[24] as well as more likely to dis-enroll or graduate from hospice services.[25]

  • Other articles found either no statistically significant difference in hospice referral and enrollment[26],[27],[28] or higher referral and enrollment rates for Black patients in certain situations.[29],[30]

  • Barriers to hospice use have also been identified, including discrimination,[31] lack of awareness of hospice services,[32] conflict with religious views,[32],[33] and a desire to continue life-prolonging treatment.[34]
  • A 2018 study of dementia decedents found that Black households provided more informal, and therefore unpaid, caregiving compared to White households.[35]

  • Another study found that when compared to White patients and caregivers, high Black caregiver-reported burden was associated with higher depressive symptoms in the patient. However, caregiver burden overall was similar between the two racial groups.[36]

  • Family resources and capacity and the difficulty of providing care in the home have been identified as barriers to hospice use by Black patients and families.[32],[33]

  • When asked what community resources would help a sample of Black caregivers of dementia patients, responses included entertainment, social, and self-care resources. Black caregivers also noted that the inability to leave their loved one unattended is a challenge to the long-term provision of care in the home. In order to help increase the use of community services, caregivers requested specific eligibility criteria and an indicator of whether the service had dementia care capabilities.[37]
  • Multiple studies found no statistically significant difference in satisfaction (e.g., satisfaction with pain management and hospice care) between Black patients and other racial groups.[38],[39]

  • Various authors reported Black family members to be either more likely[40] or less likely[41],[42] to report excellent care at the end of life.

  • One study found that compared to White patients, Black patients were less likely to receive a visit from hospice staff during their last two days of life.[43]

  • Another study found that Black caregivers reported some better hospice outcomes (e.g., receiving the training necessary to help care for their loved one) than White caregivers when served by the same hospice. However, on average, Black patients were treated by poorer quality hospices (using CAHPS data).[44]
  • Studies have consistently found that Black patients have higher rates of hospitalization,[4],[45] ED visits,[46],[47],[48] and ICU admissions[49],[50],[51] than White patients with similar serious illnesses at the end of life.

  • Several research teams also found Black patients were more likely to die in the hospital than in a hospice facility or at home when compared to White patients.[20],[52],[53],[54]

  • Another study compared the number of times a patient transitioned between care settings (e.g., long-term care facility to hospital) during the last six months of life. On average, Black patients had 3.4 transitions compared to 2.9 for White patients. They also found that Black patients were more likely to have had at least four transitions.[55]

Note: While a greater proportion of Black patients preferred life-sustaining treatment than White patients, it does not mean a majority of Black patients held a given belief. For example, while significantly different, one study found that Black patients had slightly higher odds (20%) of tracheostomy.[21]

  • Several studies found that when compared to White patients, more Black patients state a preference for life-prolonging treatment, with the potential to extend life, over comfort care only.[56],[57] For example, one study of patients with end stage renal disease found that Black patients had higher odds of preferring extending life versus comfort care only if they became critically ill.[57] This could also extend to a preference to spend their last days in the hospital.[58]

  • Not all studies, however, followed this pattern. In one study, researchers provided a list of six health scenarios (e.g., always having severe pain, living in a nursing home for the rest of their lives) to a sample of Black patients living with HIV, and asked which scenarios would be worse than death. Forty-three percent of respondents reported that all scenarios would be worse than death, suggesting a hypothetical future preference for less life-prolonging treatment, or comfort care.[59]

  • In contrast to preferences stated when asked about hypothetical end-of-life decisions in the future, other evidence suggests that compared to White patients, Black patients choose the more life-prolonging treatment in real time when the decision becomes necessary.[60],[61],[62],[63] For example, one study found that compared to White women with metastatic breast cancer (MBC), Black women with MBC had higher odds of choosing life-prolonging treatment.[60]

  • A 2016 systematic review suggested that clinician adherence to the end-of-life preferences of Black patients with cancer was lower than that for White patients.[22]

  • When studying the use of specific life-sustaining treatments, researchers found that when compared to White patients, Black patients were more likely to use breathing support,[50],[64],[65] artificial nutrition,[21],[30] and continue dialysis;[20],[66],[67] more likely to undergo CPR;[49],[68] and less likely to withdraw life-sustaining treatment.[69],[70]
  • In a survey of North Carolina and South Carolina hospices, 72.5% of respondents reported that the number of Black registered nurses on staff was too low for their population. Additionally, more than half agreed that the number of Black social workers, Black chaplains, and Black volunteers were also too low.[71]

  • Many surveyed hospices (in one study, 90%) report providing their staff with cultural competence or sensitivity training in an attempt to improve quality and utilization.[71],[72]
  • Several studies found that expenditures for Black patients living with serious illness or approaching the end of life were significantly higher than those for White patients.[73],[74],[75] A study of lung cancer patients found ICU costs for Black patients to be $4,000 higher than for White patients.[51]

  • In a study of Medicare beneficiaries, Black households were found to provide more informal (and unpaid) caregiving than non-Black families.[35]

  • One study revealed that palliative care consults that included a goals of care conversation resulted in significantly lower acute care costs for White patients, when compared to patients without palliative care consults. This pattern, however, did not hold among Black patients receiving palliative care consultations.[76]

  • Another study estimated that if Medicare hospice utilization for Black patients were equal to that of White patients (current utilization was 2.1% for Black patients compared to 2.9% for White patients), it could result in an estimated savings of $88 million per year for Medicare.[77] This does not account for a shift in out-of-pocket costs for patients and families.
  • Several studies found that Black patients are less likely to have an advance directive,[78],[79] including do-not-resuscitate (DNR) orders,[2],[80] living wills,[81] and health care proxies.[66],[81]

  • When surveying Black patients living with HIV, one study found that more than half of participants (56.2%) did not know what an advance directive or Medical Orders for Life-Sustaining Treatment (MOLST) form were. For those who had heard of ACP, those who involved their caregivers in medical decisions were more likely to have discussed ACP.[82]

  • Potential constraints to participation in ACP included the patient’s belief in its probable futility, medical mistrust (including a belief that an advance directive could result in the inappropriate or racially biased withdrawal of life-sustaining treatment against patient wishes), health literacy, and a conflict with religious beliefs.[10],[83]
  • A 2017 literature review noted social isolation, worry over burdening others, a lack of socioeconomic resources, as well as psychological distress and depression in studies of Black patients living with serious illness.[84]

  • One study found that for older Black men with serious illness, lower scores on mental and physical health-related quality of life were associated with higher levels of income difficulty and low education levels. Income difficulty was determined by participants’ response to the question, “All things considered, would you say your income (a) allows you to do more or less what you want, (b) keeps you comfortable but permits no luxuries, (c) gives you just enough to get by on, or (d) is not enough to make ends meet?”.[85]

  • In a 2020 study, researchers noted that a lack of involvement with a religious congregation was significantly associated with depressive symptoms in a sample of Black patients with cancer when compared to Black patients without depressive symptoms.[86]
  • Medical mistrust based on prior experiences in the health care system was cited in several studies as a barrier to hospice use[33],[34] and ACP.[10],[78],[83],[87]

  • In a qualitative study of Black patients and caregivers, participants stated that they felt that if they completed an advance directive, their health care providers would no longer treat them.[88]

Cultural characteristics, including the importance of the family’s responsibility in taking care of their relatives, religious beliefs, and a discomfort with discussing death, have been identified as constraints on participation in ACP[83] and hospice utilization.[31],[32],[34],[88]

  • Several studies noted that among Black patients, religious views were associated with resistance to ACP[22] and hospice enrollment.[32],[33],[34],[88]

  • Other studies, however, found that strong religious beliefs could support hospice and palliative care discussions,[89] as well as interest in quality of life interventions.[90]

  • A qualitative study found that the distribution of hospice information, when combined with chaplain efforts to support spiritual concerns, could promote hospice use in the Black community.[91]

Citations

  1. a b Booker SQ, Herr KA, Wilson Garvan C. Racial Differences in Pain Management for Patients Receiving Hospice Care. Oncol Nurs Forum. 2020;47(2):228-240. https://pubmed.ncbi.nlm.nih.gov/32078609/
  2. a b c d Burgio KL, Williams BR, Dionne-Odom JN, et al. Racial Differences in Processes of Care at End of Life in VA Medical Centers: Planned Secondary Analysis of Data from the BEACON Trial. J Palliat Med. 2016;19(2):157-163. https://pubmed.ncbi.nlm.nih.gov/26840851/
  3. a b Gerlach LB, Kales HC, Kim HM, et al. Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016. J Am Geriatr Soc. 2021;69(6):1479-1489. https://pubmed.ncbi.nlm.nih.gov/33683703/
  4. a b c Estrada LV, Agarwal M, Stone PW. Racial/Ethnic Disparities in Nursing Home End-of-Life Care: A Systematic Review. J Am Med Dir Assoc. 2021;22(2):279-290.e271. https://pubmed.ncbi.nlm.nih.gov/33428892/
  5. a b Kamal AH, Bull J, Wolf SP, Portman D, Strand J, Johnson KS. Unmet Needs of African Americans and Whites at the Time of Palliative Care Consultation. Am J Hosp Palliat Care. 2017;34(5):461-465. https://pubmed.ncbi.nlm.nih.gov/26888883/
  6. a b Check DK, Samuel CA, Rosenstein DL, Dusetzina SB. Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer. J Clin Oncol. 2016;34(19):2265-2270. https://pubmed.ncbi.nlm.nih.gov/27161968/
  7. a Rhodes RL, Xuan L, Halm EA. African American bereaved family members' perceptions of hospice quality: do hospices with high proportions of African Americans do better? J Palliat Med. 2012;15(10):1137-1141. https://pubmed.ncbi.nlm.nih.gov/22957678/
  8. a Yeager KA, Williams B, Bai J, et al. Factors Related to Adherence to Opioids in Black Patients With Cancer Pain. J Pain Symptom Manage. 2019;57(1):28-36. https://pubmed.ncbi.nlm.nih.gov/30316809/
  9. a b Dyal BW, Abudawood K, Schoppee TM, et al. Reflections of Healthcare Experiences of African Americans With Sickle Cell Disease or Cancer: A Qualitative Study. Cancer Nurs. 2021;44(1):E53-e61. https://pubmed.ncbi.nlm.nih.gov/31743153/
  10. a b c Bullock K. The influence of culture on end-of-life decision making. J Soc Work End Life Palliat Care. 2011;7(1):83-98. https://pubmed.ncbi.nlm.nih.gov/21391079/
  11. a Elliott AM, Alexander SC, Mescher CA, Mohan D, Barnato AE. Differences in Physicians' Verbal and Nonverbal Communication With Black and White Patients at the End of Life. J Pain Symptom Manage. 2016;51(1):1-8. https://pubmed.ncbi.nlm.nih.gov/26297851/
  12. a Smith-Howell ER, Hickman SE, Meghani SH, Perkins SM, Rawl SM. End-of-Life Decision Making and Communication of Bereaved Family Members of African Americans with Serious Illness. J Palliat Med. 2016;19(2):174-182. https://pubmed.ncbi.nlm.nih.gov/26840853/
  13. a b Cole AP, Nguyen DD, Meirkhanov A, et al. Association of Care at Minority-Serving vs Non-Minority-Serving Hospitals With Use of Palliative Care Among Racial/Ethnic Minorities With Metastatic Cancer in the United States. JAMA Netw Open. 2019;2(2):e187633. https://pubmed.ncbi.nlm.nih.gov/30707230/
  14. a Khan MZ, Zahid S, Kichloo A, et al. Gender, racial, ethnic and socioeconomic disparities in palliative care encounters in ischemic strokes admissions. Cardiovasc Revasc Med. 2021. https://pubmed.ncbi.nlm.nih.gov/33863656/
  15. a Singh T, Peters SR, Tirschwell DL, Creutzfeldt CJ. Palliative Care for Hospitalized Patients With Stroke: Results From the 2010 to 2012 National Inpatient Sample. Stroke. 2017;48(9):2534-2540. https://pubmed.ncbi.nlm.nih.gov/28818864/
  16. a Lillemoe K, Lord A, Torres J, Ishida K, Czeisler B, Lewis A. Factors Associated With DNR Status After Nontraumatic Intracranial Hemorrhage. Neurohospitalist. 2020;10(3):168-175. https://pubmed.ncbi.nlm.nih.gov/32549939/
  17. a Johnson T, Walton S, Jr., Levine S, Fister E, Baron A, O'Mahony S. Racial and ethnic disparity in palliative care and hospice use. Am J Manag Care. 2020;26(2):e36-e40. https://pubmed.ncbi.nlm.nih.gov/32059098/
  18. a Subramaniam AV, Patlolla SH, Cheungpasitporn W, et al. Racial and Ethnic Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction. J Am Heart Assoc. 2021;10(11):e019907. https://pubmed.ncbi.nlm.nih.gov/34013741/
  19. a Sharma RK, Cameron KA, Chmiel JS, et al. Racial/Ethnic Differences in Inpatient Palliative Care Consultation for Patients With Advanced Cancer. J Clin Oncol. 2015;33(32):3802-3808. https://pubmed.ncbi.nlm.nih.gov/26324373/
  20. a b c Thomas BA, Rodriguez RA, Boyko EJ, Robinson-Cohen C, Fitzpatrick AL, O'Hare AM. Geographic variation in black-white differences in end-of-life care for patients with ESRD. Clin J Am Soc Nephrol. 2013;8(7):1171-1178. https://pubmed.ncbi.nlm.nih.gov/23580783/
  21. a b c Jones RC, Creutzfeldt CJ, Cox CE, et al. Racial and Ethnic Differences in Health Care Utilization Following Severe Acute Brain Injury in the United States. J Intensive Care Med. 2020:885066620945911. https://pubmed.ncbi.nlm.nih.gov/32912070/
  22. a b c LoPresti MA, Dement F, Gold HT. End-of-Life Care for People With Cancer From Ethnic Minority Groups: A Systematic Review. Am J Hosp Palliat Care. 2016;33(3):291-305. https://pubmed.ncbi.nlm.nih.gov/25550406/
  23. a Wang SY, Hsu SH, Huang S, Doan KC, Gross CP, Ma X. Regional Practice Patterns and Racial/Ethnic Differences in Intensity of End-of-Life Care. Health Serv Res. 2018;53(6):4291-4309. https://pubmed.ncbi.nlm.nih.gov/29951996/
  24. a Karanth S, Rajan SS, Sharma G, Yamal JM, Morgan RO. Racial-Ethnic Disparities in End-of-Life Care Quality among Lung Cancer Patients: A SEER-Medicare-Based Study. J Thorac Oncol. 2018;13(8):1083-1093. https://pubmed.ncbi.nlm.nih.gov/29753578/
  25. a Rizzuto J, Aldridge MD. Racial Disparities in Hospice Outcomes: A Race or Hospice-Level Effect? J Am Geriatr Soc. 2018;66(2):407-413. https://pubmed.ncbi.nlm.nih.gov/29250770/
  26. a Johnson KS, Kuchibhatla M, Payne R, Tulsky JA. Race and residence: intercounty variation in black-white differences in hospice use. J Pain Symptom Manage. 2013;46(5):681-690. https://pubmed.ncbi.nlm.nih.gov/23522516/
  27. a Worster B, Bell DK, Roy V, Cunningham A, LaNoue M, Parks S. Race as a Predictor of Palliative Care Referral Time, Hospice Utilization, and Hospital Length of Stay: A Retrospective Noncomparative Analysis. Am J Hosp Palliat Care. 2018;35(1):110-116. https://pubmed.ncbi.nlm.nih.gov/28056514/
  28. a Zullig LL, Carpenter WR, Provenzale DT, et al. The association of race with timeliness of care and survival among Veterans Affairs health care system patients with late-stage non-small cell lung cancer. Cancer Manag Res. 2013;5:157-163. https://pubmed.ncbi.nlm.nih.gov/23900515/
  29. a Sharma RK, Dy SM. Documentation of information and care planning for patients with advanced cancer: associations with patient characteristics and utilization of hospital care. Am J Hosp Palliat Care. 2011;28(8):543-549. https://pubmed.ncbi.nlm.nih.gov/21454317/
  30. a b Connolly A, Sampson EL, Purandare N. End-of-life care for people with dementia from ethnic minority groups: a systematic review. J Am Geriatr Soc. 2012;60(2):351-360. https://pubmed.ncbi.nlm.nih.gov/22332675/
  31. a b Dillon PJ, Basu A. African Americans and Hospice Care: A Culture-Centered Exploration of Enrollment Disparities. Health Commun. 2016;31(11):1385-1394. https://pubmed.ncbi.nlm.nih.gov/27007165/
  32. a b c d e Reese DJ, Smith MR, Butler C, Shrestha S, Erwin DO. African American client satisfaction with hospice: a comparison of primary caregiver experiences within and outside of hospice. Am J Hosp Palliat Care. 2014;31(5):495-502. https://pubmed.ncbi.nlm.nih.gov/23838454/
  33. a b c d Rhodes RL, Batchelor K, Lee SC, Halm EA. Barriers to end-of-life care for African Americans from the providers' perspective: opportunity for intervention development. Am J Hosp Palliat Care. 2015;32(2):137-143. https://pubmed.ncbi.nlm.nih.gov/24097838/
  34. a b c d Spruill AD, Mayer DK, Hamilton JB. Barriers in Hospice Use Among African Americans With Cancer. Journal of Hospice & Palliative Nursing. 2013;15(3):136-144. https://journals.lww.com/jhpn/Fulltext/2013/05000/Barriers_in_Hospice_Use_Among_African_Americans.3.aspx
  35. a b Kelley AS, McGarry K, Gorges R, Skinner JS. The burden of health care costs for patients with dementia in the last 5 years of life. Ann Intern Med. 2015;163(10):729-736. https://pubmed.ncbi.nlm.nih.gov/26502320/
  36. a Ejem D, Bauldry S, Bakitas M, Drentea P. Caregiver Burden, Care Recipient Depressive Symptomology, and Social Exchange: Does Race Matter? J Palliat Care. 2018;33(2):100-108. https://pubmed.ncbi.nlm.nih.gov/29514553/
  37. a Abramsohn EM, Jerome J, Paradise K, Kostas T, Spacht WA, Lindau ST. Community resource referral needs among African American dementia caregivers in an urban community: a qualitative study. BMC Geriatr. 2019;19(1):311. https://pubmed.ncbi.nlm.nih.gov/31727000/
  38. a Campbell CL, Baernholdt M, Yan G, Hinton ID, Lewis E. Racial/ethnic perspectives on the quality of hospice care. Am J Hosp Palliat Care. 2013;30(4):347-353. https://pubmed.ncbi.nlm.nih.gov/22952128/
  39. a Chuang E, Fiter RJ, Sanon OC, et al. Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit. Am J Hosp Palliat Care. 2020;37(10):823-829. https://pubmed.ncbi.nlm.nih.gov/32237996/
  40. a Luth EA, Prigerson HG. Associations between Race and Dementia Status and the Quality of End-of-Life Care. J Palliat Med. 2018;21(7):970-977. https://pubmed.ncbi.nlm.nih.gov/29620949/
  41. a Kutney-Lee A, Smith D, Thorpe J, Del Rosario C, Ibrahim S, Ersek M. Race/Ethnicity and End-of-Life Care Among Veterans. Med Care. 2017;55(4):342-351. https://pubmed.ncbi.nlm.nih.gov/27579913/
  42. a Rhodes RL, Teno JM, Connor SR. 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. https://pubmed.ncbi.nlm.nih.gov/17900854/
  43. a Teno JM, Plotzke M, Christian T, Gozalo P. Examining Variation in Hospice Visits by Professional Staff in the Last 2 Days of Life. JAMA Intern Med. 2016;176(3):364-370. https://pubmed.ncbi.nlm.nih.gov/26857275/
  44. a Price RA, Parast L, Haas A, Teno JM, Elliott MN. Black And Hispanic Patients Receive Hospice Care Similar To That Of White Patients When In The Same Hospices. Health Aff (Millwood). 2017;36(7):1283-1290. https://pubmed.ncbi.nlm.nih.gov/28679816/
  45. a Russell D, Baik D, Jordan L, et al. Factors Associated With Live Discharge of Heart Failure Patients From Hospice: A Multimethod Study. JACC Heart Fail. 2019;7(7):550-557. https://pubmed.ncbi.nlm.nih.gov/31078473/
  46. a Guadagnolo BA, Liao KP, Giordano SH, Elting LS, Shih YC. Variation in Intensity and Costs of Care by Payer and Race for Patients Dying of Cancer in Texas: An Analysis of Registry-linked Medicaid, Medicare, and Dually Eligible Claims Data. Med Care. 2015;53(7):591-598. https://pubmed.ncbi.nlm.nih.gov/26067883/
  47. a Perry LM, Walsh LE, Horswell R, et al. Racial Disparities in End-of-Life Care Between Black and White Adults With Metastatic Cancer. J Pain Symptom Manage. 2021;61(2):342-349.e341. https://pubmed.ncbi.nlm.nih.gov/32947018/
  48. a Samuel-Ryals CA, Mbah OM, Hinton SP, Cross SH, Reeve BB, Dusetzina SB. Evaluating the Contribution of Patient-Provider Communication and Cancer Diagnosis to Racial Disparities in End-of-Life Care Among Medicare Beneficiaries. J Gen Intern Med. 2021;36(11):3311-3320. https://pubmed.ncbi.nlm.nih.gov/33963508/
  49. a b Abdollah F, Sammon JD, Majumder K, et al. Racial Disparities in End-of-Life Care Among Patients With Prostate Cancer: A Population-Based Study. J Natl Compr Canc Netw. 2015;13(9):1131-1138. https://pubmed.ncbi.nlm.nih.gov/26358797/
  50. a b Brown CE, Engelberg RA, Sharma R, et al. Race/Ethnicity, Socioeconomic Status, and Healthcare Intensity at the End of Life. J Palliat Med. 2018;21(9):1308-1316. https://pubmed.ncbi.nlm.nih.gov/29893618/
  51. a b Chen Y, Criss SD, Watson TR, et al. Cost and Utilization of Lung Cancer End-of-Life Care Among Racial-Ethnic Minority Groups in the United States. Oncologist. 2020;25(1):e120-e129. https://pubmed.ncbi.nlm.nih.gov/31501272/
  52. a Chino F, Kamal AH, Leblanc TW, Zafar SY, Suneja G, Chino JP. Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities. Cancer. 2018;124(22):4408-4419. https://pubmed.ncbi.nlm.nih.gov/30343501/
  53. a Cross SH, Ely EW, Kavalieratos D, Tulsky JA, Warraich HJ. Place of Death for Individuals With Chronic Lung Disease: Trends and Associated Factors From 2003 to 2017 in the United States. Chest. 2020;158(2):670-680. https://pubmed.ncbi.nlm.nih.gov/32229227/
  54. a Sedhom R, Kuo PL, Gupta A, et al. Changes in the place of death for older adults with cancer: Reason to celebrate or a risk for unintended disparities? J Geriatr Oncol. 2021;12(3):361-367. https://pubmed.ncbi.nlm.nih.gov/33121909/
  55. a Wang SY, Hsu SH, Aldridge MD, Cherlin E, Bradley E. Racial Differences in Health Care Transitions and Hospice Use at the End of Life. J Palliat Med. 2019;22(6):619-627. https://pubmed.ncbi.nlm.nih.gov/30615546/
  56. a Garrido MM, Harrington ST, Prigerson HG. End-of-life treatment preferences: a key to reducing ethnic/racial disparities in advance care planning? Cancer. 2014;120(24):3981-3986. https://pubmed.ncbi.nlm.nih.gov/25145489/
  57. a b Eneanya ND, Wenger JB, Waite K, et al. Racial Disparities in End-of-Life Communication and Preferences among Chronic Kidney Disease Patients. Am J Nephrol. 2016;44(1):46-53. https://pubmed.ncbi.nlm.nih.gov/27351650/
  58. a Boyce-Fappiano D, Liao K, Miller C, Peterson SK, Elting LS, Guadagnolo BA. Greater preferences for death in hospital and mechanical ventilation at the end of life among non-whites recently diagnosed with cancer. Support Care Cancer. 2021. https://pubmed.ncbi.nlm.nih.gov/33913005/
  59. a Mitchell MM, Hansen ED, Tseng TY, et al. Correlates of Patterns of Health Values of African Americans Living With HIV/AIDS: Implications for Advance Care Planning and HIV Palliative Care. J Pain Symptom Manage. 2018;56(1):53-62. https://pubmed.ncbi.nlm.nih.gov/29526613/
  60. a b Accordino MK, Wright JD, Vasan S, et al. Association between survival time with metastatic breast cancer and aggressive end-of-life care. Breast Cancer Res Treat. 2017;166(2):549-558. https://pubmed.ncbi.nlm.nih.gov/28752188/
  61. a Benton K, Stephens J, Vogel R, et al. The influence of race on end-of-life choices following a counselor-based palliative consultation. Am J Hosp Palliat Care. 2015;32(1):84-89. https://pubmed.ncbi.nlm.nih.gov/24085311/
  62. a Ormseth CH, Falcone GJ, Jasak SD, et al. Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage. Neurocrit Care. 2018;29(3):419-425. https://pubmed.ncbi.nlm.nih.gov/29949003/
  63. a Yang A GD, Nova J, Malhotra J, Cantor JC, Tsui J. Racial Disparities in Health Care Utilization at the End of Life Among New Jersey Medicaid Beneficiaries With Advanced Cancer. JCO Oncol Pract. 2020;16(6):e538-e548. https://pubmed.ncbi.nlm.nih.gov/32298223/
  64. a Sharma RK, Kim H, Gozalo PL, Sullivan DR, Bunker J, Teno JM. The Black and White of Invasive Mechanical Ventilation in Advanced Dementia. J Am Geriatr Soc. 2020;68(9):2106-2111. https://pubmed.ncbi.nlm.nih.gov/32710813/
  65. a Woo KK, Can A, Chang DW. Racial Differences in the Utilization of Guideline-Recommended and Life-Sustaining Procedures During Hospitalizations for Out-of-Hospital Cardiac Arrest. J Racial Ethn Health Disparities. 2020;7(3):403-412. https://pubmed.ncbi.nlm.nih.gov/31845289/
  66. a b Rahemi Z, Williams CL. Older Adults of Underrepresented Populations and Their End-of-Life Preferences: An Integrative Review. ANS Adv Nurs Sci. 2016;39(4):E1-E29. https://pubmed.ncbi.nlm.nih.gov/27677181/
  67. a Foley RN, Sexton DJ, Drawz P, Ishani A, Reule S. Race, Ethnicity, and End-of-Life Care in Dialysis Patients in the United States. J Am Soc Nephrol. 2018;29(9):2387-2399. https://pubmed.ncbi.nlm.nih.gov/30093455/
  68. a Hernandez RA, Hevelone ND, Lopez L, Finlayson SR, Chittenden E, Cooper Z. Racial variation in the use of life-sustaining treatments among patients who die after major elective surgery. Am J Surg. 2015;210(1):52-58. https://pubmed.ncbi.nlm.nih.gov/25465749/
  69. a Williams BM, Schneider A, Gallaher J, Charles A. Racial and ethnic disparities in withdrawal of life-sustaining treatment after non-head injury trauma. Am J Surg. 2021. https://pubmed.ncbi.nlm.nih.gov/34384589/
  70. a Williamson T, Ryser MD, Ubel PA, et al. Withdrawal of Life-supporting Treatment in Severe Traumatic Brain Injury. JAMA Surg. 2020;155(8):723-731. https://pubmed.ncbi.nlm.nih.gov/32584926/
  71. a b Johnson KS, Payne R, Kuchibhatla MN. What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area? J Palliat Med. 2016;19(2):183-189. https://pubmed.ncbi.nlm.nih.gov/26840854/
  72. a Boucher NA, Johnson KS. Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients? Am J Hosp Palliat Care. 2021;38(2):169-174. https://pubmed.ncbi.nlm.nih.gov/32734763/
  73. a Byhoff E, Harris JA, Langa KM, Iwashyna TJ. Racial and Ethnic Differences in End-of-Life Medicare Expenditures. J Am Geriatr Soc. 2016;64(9):1789-1797. https://pubmed.ncbi.nlm.nih.gov/27588580/
  74. a Leibowitz AA, Tan D, Gildner JL. The Effect of Hospice on End-of-Life Costs for Terminal Medicare Patients With HIV. Inquiry. 2020;57:46958020969381. https://pubmed.ncbi.nlm.nih.gov/33118403/
  75. a Ornstein KA, Zhu WC, Bollens-Lund E, et al. Medicare Expenditures and Health Care Utilization in a Multiethnic Community-based Population With Dementia From Incidence to Death. Alzheimer Dis Assoc Disord. 2018;32(4):320-325. https://pubmed.ncbi.nlm.nih.gov/29734263/
  76. a Starr LT, Ulrich CM, Appel SM, Junker P, O'Connor NR, Meghani SH. Goals-of-Care Consultations Are Associated with Lower Costs and Less Acute Care Use among Propensity-Matched Cohorts of African Americans and Whites with Serious Illness. J Palliat Med. 2020;23(9):1204-1213. https://pubmed.ncbi.nlm.nih.gov/32345109/
  77. a Hughes MC, Vernon E. Closing the Gap in Hospice Utilization for the Minority Medicare Population. Gerontol Geriatr Med. 2019;5:2333721419855667. https://pubmed.ncbi.nlm.nih.gov/31276019/
  78. a b Wicher CP, Meeker MA. What influences African American end-of-life preferences? J Health Care Poor Underserved. 2012;23(1):28-58. https://pubmed.ncbi.nlm.nih.gov/22643461/
  79. a Hoe DF, Enguidanos S. So Help Me, God: Religiosity and End-of-Life Choices in a Nationally Representative Sample. J Palliat Med. 2020;23(4):563-567. https://pubmed.ncbi.nlm.nih.gov/31553272/
  80. a Kabaria S, Gupta K, Bhurwal A, Patel AV, Rustgi VK. Predictors of do-not-resuscitate order utilization in decompensated cirrhosis hospitalized patients: A nationwide inpatient cohort study. Ann Hepatol. 2021;22:100284. https://pubmed.ncbi.nlm.nih.gov/33160032/
  81. a b Eneanya ND, Olaniran K, Xu D, et al. Health Literacy Mediates Racial Disparities in Cardiopulmonary Resuscitation Knowledge among Chronic Kidney Disease Patients. J Health Care Poor Underserved. 2018;29(3):1069-1082. https://pubmed.ncbi.nlm.nih.gov/30122684/
  82. a Maragh-Bass AC, Zhao Y, Isenberg SR, Mitchell MM, Knowlton AR. Have You Talked about It: Advance Care Planning among African Americans Living with HIV in Baltimore. J Urban Health. 2017;94(5):730-745. https://pubmed.ncbi.nlm.nih.gov/28560611/
  83. a b c Collins JW, Zoucha R, Lockhart JS, Mixer SJ. Cultural Aspects of End-of-Life Care Planning for African Americans: An Integrative Review of Literature. J Transcult Nurs. 2018;29(6):578-590. https://pubmed.ncbi.nlm.nih.gov/29357786/
  84. a Coats HL. African American elders' psychological-social-spiritual cultural experiences across serious illness: an integrative literature review through a palliative care lens. Ann Palliat Med. 2017;6(3):253-269. https://pubmed.ncbi.nlm.nih.gov/28595425/
  85. a Clay OJ, Perkins M, Wallace G, Crowe M, Sawyer P, Brown CJ. Associations of Multimorbid Medical Conditions and Health-Related Quality of Life Among Older African American Men. J Gerontol B Psychol Sci Soc Sci. 2018;73(2):258-266. https://pubmed.ncbi.nlm.nih.gov/28658936/
  86. a Kang Y, Meghani SH, Bruner DW, Yeager KA. Factors Associated with Depression in African American Patients Being Treated for Cancer Pain. Pain Manag Nurs. 2020;21(5):410-415. https://pubmed.ncbi.nlm.nih.gov/32513560/
  87. a Sanders JJ, Johnson KS, Cannady K, et al. From Barriers to Assets: Rethinking factors impacting advance care planning for African Americans. Palliat Support Care. 2019;17(3):306-313. https://pubmed.ncbi.nlm.nih.gov/29869594/
  88. a b c Rhodes RL, Elwood B, Lee SC, Tiro JA, Halm EA, Skinner CS. The Desires of Their Hearts: The Multidisciplinary Perspectives of African Americans on End-of-Life Care in the African American Community. Am J Hosp Palliat Care. 2017;34(6):510-517. https://pubmed.ncbi.nlm.nih.gov/26878868/
  89. a Johnson J, Hayden T, True J, et al. The Impact of Faith Beliefs on Perceptions of End-of-Life Care and Decision Making among African American Church Members. J Palliat Med. 2016;19(2):143-148. https://pubmed.ncbi.nlm.nih.gov/26840849/
  90. a Maragh-Bass AC, Sloan DH, Alghanim F, Knowlton AR. A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV. Qual Life Res. 2021;30(2):507-519. https://pubmed.ncbi.nlm.nih.gov/33052513/
  91. a Noh H, Schroepfer TA. Terminally ill African American elders' access to and use of hospice care. Am J Hosp Palliat Care. 2015;32(3):286-297. https://pubmed.ncbi.nlm.nih.gov/24413609/

Get the latest updates in your inbox!