Hospice rules may deter some African Americans

NEW YORK (Reuters Health) - African Americans are less likely than whites to seek end-of-life hospice care — and a new study suggests that hospice admission criteria may be partially to blame.

The researchers found that compared with whites African Americans are more likely to want to continue aggressive treatment and expressed a need for more services.

The findings also suggest it might be time to redesign hospice enrollment rules, the investigators suggest.

Hospice is an interdisciplinary program that offers terminally ill patients palliative care — treating pain and other physical and emotional symptoms to make patients more comfortable in their last months of life.

Right now, Medicare will pay for hospice care only when patients have a life expectancy of no more than 6 months and are willing to forgo any further attempts at curative treatment, lead investigator Dr. Jessica Fishman of the University of Pennsylvania in Philadelphia state in the medical journal Cancer.

The Medicare criteria were designed to control costs, Fishman’s team notes, but they have “substantially reduced access to hospice for many patients who have needs for hospice services, and a disproportionate number of these patients are African American.”

The study included 283 cancer patients who were estimated to have 6 months or less to live. The researchers interviewed them about their preferences for continuing aggressive treatment and about their perceived need for various hospice services — like having a home health aide help them with daily tasks, or getting counseling for depression or anxiety.

As mentioned, Fishman and her colleagues found that African American patients were more likely than white patients to want to continue treatment, but they also voiced a greater perceived need for hospice services.

The latter finding, the researchers say, seemed to be explained by the fact that African Americans generally had fewer financial resources than white patients.

The results, Fishman’s team argues, indicate that Medicare criteria “do not select those patients with the greatest needs for hospice services.”

The rules are also “unfair,” the researchers contend, pointing out that other Medicare-supported services do not require patients to forgo one treatment to get another.

“To the degree that this eligibility requirement prevents hospice use by the patients with the greatest needs,” the researchers write, “it fails to fulfill its purpose and should be reconsidered.”

SOURCE: Cancer, February 1, 2009.


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