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African Americans, death and dying, health disparities, hospice



  1. Spruill, Angela D. MSN, ANP-BC, OCN
  2. Mayer, Deborah K. PhD, RN, AOCN, FAAN
  3. Hamilton, Jill B. PhD, RN


Forty percent of the deaths that occur in the United States used hospice services, but that number is much smaller for African Americans. African Americans' underutilization of hospice services may not offer them the benefits of this holistic model of end-of-life care. Several factors have been hypothesized for underutilization and include cultural, environmental, religious, and historical perspectives. The purpose of this literature review was to explore the barriers preventing African Americans with cancer from using hospice services. Documentation of underutilization, desire for aggressive care, knowledge of hospice, lack of diversity among hospice staff, religious/hope beliefs, mistrust of the healthcare system, and access to hospice were identified in this review as barriers to use. Interventions should target these barriers to increase utilization. We also need to better understand how African Americans die when not in hospice.