Underutilization of Hospice in Older African Americans

老年非裔美国人临终关怀未得到充分利用

• 批准号: 9806215
• 负责人: Channing E Tate
• 金额: $ 7.38万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9806215
• 关键词: Address; African American; Aging; Attitude; Automobile Driving; Belief; Cessation of life; Communities; Data; Decision Aid; Decision Making; Dementia; Diagnosis; Discrimination; Elderly; Emotional; Enrollment; Ethnic Origin; Event; Face; Goals; Health Status; Healthcare; Heart Diseases; Hospice Care; Individual; Knowledge; Lead; Literature; Malignant Neoplasms; Mediating; Medical; Mentors; Needs Assessment; Occupations; Pain management; Participant; Patients; Persons; Population; Positioning Attribute; Quality of life; Race; Reporting; Research; Research Personnel; Research Project Grants; Science; Services; Syphilis; Time; Trust; Work; advanced disease; aged; base; caucasian American; design; education access; end of life care; evidence base; experience; experimental study; health care availability; health disparity; health equity; health literacy; hospice environment; human old age (65+); improved; literacy; loved ones; low socioeconomic status; minority communities; prevent; racial diversity; satisfaction; shared decision making

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).

项目总结/文摘