# Underutilization of Hospice in Older African Americans

> **NIH NIH R36** · UNIVERSITY OF COLORADO DENVER · 2020 · $73,724

## Abstract

Project Summary/Abstract
Hospice is underutilized, especially among African Americans (AA). Despite the documented benefits of
hospice, less than 2 million people utilize hospice services annually. Underuse disparities are extreme across
race and ethnicity as White Americans comprise 85% of all hospice enrollees. AAs account for only 8% of
hospice enrollees but are more likely to die from the top three hospice diagnoses (i.e. cancer, heart disease
and dementia) than White Americans. Even when AAs enroll in hospice, they spend less time in hospice than
White patients, averaging fewer than seven days in hospice care. Notably, AA hospice enrollees report a
higher degree of satisfaction with end of life care when hospice is involved, as compared to AAs who are not
enrolled in hospice care. There are several potential barriers that may prevent AAs from enrolling in hospice
care including lack of knowledge of hospice care, mistrust in healthcare, perceived discrimination, health
literacy. AAs routinely report less knowledge of hospice than White Americans, and the information that AA
know about hospice often comes from non-medical professionals and is inaccurate. Some AA have persistent
mistrust in healthcare due to events such as the Tuskegee Syphilis Experiments and many AA perceive
discrimination when accessing healthcare. Data shows that health literacy is a stronger predictor of hospice
use than race and older AAs are more likely to possess low health literacy. The driving hypothesis of this
research is that by providing clear and accurate information to older AAs will help address the underutilization
of hospice by clarifying misperceptions, building trust, and overcoming literacy barriers. Patient decision aids
(PtDAs) are an evidence-based approach to improve patient agency in medical decision making. Research
shows that AA report a desire for more agency and autonomy in decision-making yet the use of PtDAs is
understudied in AA communities. This proposal offers a unique opportunity to address many of the potential
barriers that may prevent older AAs from enrolling in hospice, while simultaneously expanding the literature of
SDM specific to older AAs. The goals of this proposal are to evaluate if the relationships between health
literacy and hospice knowledge, attitudes, and beliefs is mediated by mistrust in healthcare and perceived
discrimination among AAs aged 65 or older (Aim1) and to evaluate the effect of the hospice PtDA on changing
hospice knowledge and attitudes and beliefs about hospice in AA aged 65 and older (Aim 2).

## Key facts

- **NIH application ID:** 9985691
- **Project number:** 5R36AG064135-02
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Channing E Tate
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $73,724
- **Award type:** 5
- **Project period:** 2019-08-01 → 2021-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9985691

## Citation

> US National Institutes of Health, RePORTER application 9985691, Underutilization of Hospice in Older African Americans (5R36AG064135-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9985691. Licensed CC0.

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