Cultural Beliefs May Keep Blacks From Ho... (dge and opinion of hospice care. Firs...)

Cultural Beliefs May Keep Blacks From Hospice Care

Date:2/5/2008

dge and opinion of hospice care.

First of all, older whites were much better informed about hospice compared to their black peers, the study found. While 4 percent of whites said they had never heard of hospice, more than 21 percent of blacks said they were unfamiliar with the concept.

Certain spiritual beliefs also seemed to work against hospice as an end-of-life choice for blacks. "African-Americans were more likely to believe that pain and suffering is sometimes 'part of God's plan' for your life," Johnson said. "Something like that would be inconsistent with the hospice philosophy."

Blacks were also much more likely than whites to press for continued treatment of the underlying disease -- even when the chance that it would help was slim. These individuals may view hospice as "giving up" and therefore resist enrolling in such care, Johnson said.

The biggest factor at play seemed to be a widely held mistrust of the health-care system, coupled with the sense that the system is generally less accessible to black patients. Issues of "trust seemed to explain the racial disparity more than any other factor," Johnson said.

None of this surprises another expert in the field, Ronald Barrett, a psychology professor at Loyola Marymount University in Los Angeles.

"The [historical] stigma and the mistrust of the health-care system is still there," Barrett said. "So, hospice institutions have opened their doors and they are wondering why blacks aren't coming? It's because they have this long history of feeling unwelcome, disenfranchised and marginalized."

Income and insurance concerns also play a role, Johnson said. More than one-third (34 percent) of blacks in the survey thought they could not afford hospice care even if they wanted it, compared to 20 percent of whites. The truth is that the service is typically covered by Medicare, Johnson pointed out.

"Still, among my own patients I'm often
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