Barriers to Hospice Use Among African Americans: A Systematic Review (Report‪)‬

Approximately 1.3 million dying individuals and their family members received services from a hospice agency in 2006 (National Hospice and Palliative Care Organization [NHPCO], 2007). Hospice providers work to ensure that patients experience a death that is as natural, dignified, and pain-free as possible. A number of services are typically provided to hospice patients, including care from nurses, social workers, chaplains, physicians, and volunteers. Often, hospice involvement enables individuals to die in their own homes with care and support from loved ones (NHPCO, 2006). Despite the many benefits of hospice, the general public continues to be resistant to end-of-life care for a variety of reasons. It is well documented that the majority of the population, regardless of race or ethnicity, is unfamiliar with hospice (Asch-Goodkin, Caloras, Coloney, Kangas, & Wegryn, 2000; Berg-Klug, Gessert, & Forbes, 2001; Casarett, Crowley, & Hirschman, 2004; Han, Remsburg, McAuley, Keay, & Travis, 2006; Myers, 2002). Similarly, concern about burdening family members with caregiving needs is ubiquitous (McCarthy, Burns, Davis, & Phillips, 2003; Rabow, Hauser, & Adams, 2004; Tang, 2003; Wong, Liu, Szeto, Sham, & Chan, 2004). Personal, cultural, and spiritual values related to end of life are also predominant throughout the population (Clements et al., 2003; Grime, Nelson-Marten & Muchka, 2004; McGrath, 2003; Myers, 2002). At times, these beliefs may be in conflict with hospice services, which are designed to provide comfort care rather than curative treatment. Finally, because accepting hospice care typically means discontinuing or refusing to initiate life-prolonging treatment, individuals may need to re-evaluate the meaning they attach to the concept of hope before transitioning to hospice services. In recent years, considerable research has been conducted related to the meaning of hope as it pertains to the terminally ill population (Fallowfield, Jenkins, & Beveridge, 2002; Groopman, 2004; Parker-Oliver, 2002; Parker et al., 2001).