Race, treatment preferences, and hospice enrollment: eligibility criteria may exclude patients with the greatest needs for care

Cancer. 2009 Feb 1;115(3):689-97. doi: 10.1002/cncr.24046.


Background: The requirement that patients give up curative treatment makes hospice enrollment unappealing for some patients and may particularly limit use among African-American patients. The current study was conducted to determine whether African-American patients with cancer are more likely than white patients to have preferences for cancer treatment that exclude them from hospice and whether they are less likely to want specific hospice services.

Methods: Two hundred eighty-three patients who were receiving treatment for cancer at 6 oncology clinics within the University of Pennsylvania Cancer Network completed conjoint interviews measuring their perceived need for 5 hospice services and their preferences for continuing cancer treatment. Patients were followed for 6 months or until death.

Results: African-American patients had stronger preferences for continuing their cancer treatments on a 7-point scale even after adjusting for age, sex, finances, education, Eastern Cooperative Oncology Group performance status, quality of life, and physical and psychologic symptom burden (adjusted mean score, 4.75 vs 3.96; beta coefficient, 0.82; 95% confidence interval, 0.22-1.41 [P = .007]). African-American patients also had greater perceived needs for hospice services after adjusting for these characteristics (adjusted mean score, 2.31 vs 1.83; beta coefficient, 0.51; 95% confidence interval, 0.11-0.92 [P = .01]). However, this effect disappeared after adjusting for household finances.

Conclusions: Hospice eligibility criteria may exclude African-American patients disproportionately despite greater perceived needs for hospice services in this population. The mechanisms driving this health disparity likely include both cultural differences and economic characteristics, and consideration should be given to redesigning hospice eligibility criteria.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Black or African American / psychology*
  • Eligibility Determination*
  • Female
  • Health Services Accessibility
  • Health Services Needs and Demand*
  • Healthcare Disparities*
  • Hospice Care / psychology*
  • Hospice Care / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / psychology
  • Neoplasms / therapy*
  • Patient Participation
  • Patient Satisfaction*
  • Socioeconomic Factors
  • White People