Serious Illness Care Quality, Communications Lacking for Black Hospice Patients


When it comes to communication and quality of care for Black patients, recent data reinforces the notion that hospices have room to grow.

The Center to Advance Palliative Care (CAPC) recently released key findings in its research review aimed at uncovering disparities in serious illness care quality and patient experiences among underserved populations.

Among the most significant findings of the review was that Black patients with serious illnesses reported receiving poorer quality pain and symptom management compared to other groups. Communication with patients and families was also lacking, according to researchers.

The core of these issues largely rests in the hands of health care providers, according to researcher Brittany Chambers, director of health equity and special initiatives at CAPC.

“Our review found that Black patients with serious illness report poor-quality clinician-patient relationships and communication,” Chambers told Hospice News in an email. “Due to structural racism and biases, the literature supports that there is unequal treatment for this patient population. Providers should acknowledge this reality and work to address these specific sources of suffering for their Black patients.”

Last year, CAPC launched a “Project Equity” workgroup, which examined health equity studies, articles and various other literature. The research mostly spanned the last decade and featured data from PubMed, the Journal of Palliative Medicine, the American Journal of Hospice and Palliative Medicine, and the Journal of Pain and Symptom Management, among several other publications.

In CAPC’s recent key findings analysis, researchers found that Black patients were more likely to report pain severity than white populations, and also more likely to have concerns about unmet pain needs. Various studies found that medications for symptom management were used less frequently in Black patients than others.

Additionally, bereaved family members of Black patients rated the quality of communication with hospices as lower than other health care providers. The studies showed lower quality scores from these families, as well as higher feelings of decisional conflict due to a lack of communication.

Though racial disparities have long-proliferated in health care, hospices have been among the settings seeing widening gaps.

Hospice utilization among diverse populations is currently lacking. African Americans made up a mere 8.2% of Medicare decedents in 2018, according to the National Hospice and Palliative Care Organization. Although this was higher than other minority groups, it paled in comparison to the 82% that were Caucasian that year.

CAPC’s research analysis reflected this lacking utilization trend as well.

Several studies found that Black patients were less likely than others to be referred to hospice and also less likely to receive palliative care compared to white patients, Chambers stated.

Recognizing a need for improvement, more hospices have worked to step up their diversity, equity and inclusion efforts in recent years. Providers have focused on having more inclusivity in their outreach and messaging, incorporatd more health equity components into staff training and education, and honored in on greater representation of more diverse interdisciplinary teams.

But these efforts can sometimes fall short in creating effective and lasting change.

Hospices need to improve staff awareness and training around these health care disparities, and also put mechanisms into place that ensure accountability for better patient care and family support, according to Chambers.

Providers should implement standardized routine patient screenings for symptom distress, functional impairment and caregiver burden, Chambers stated. Making these evaluations standardized across the board could help to reduce any provider implicit biases, she added.

Representation among staff and expanded diversity education are also important keys, Chambers continued. Investing in more inclusive and diverse training resources can be one step closer to moving the needle of change forward, she indicated.

Many surveyed hospices (in one study, 90%) reported providing their staff with cultural competence or sensitivity training in an attempt to improve quality and utilization, Chambers noted.

“Efforts to work on staff diversity are important to ensure the staffing demographics better reflects the patient population,” Chambers said. “Investing in high quality staff training and onboarding can also help with more equitable access. These trainings should be high-quality and happen on an ongoing basis as the evidence base on what is the most effective continues to evolve.”

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