[Mar 19, 2007]

      Fewer minorities than whites use hospice care for end-of-life services, in part because of health insurance policies, cost and cultural differences, according to a report released on Thursday by the California HealthCare Foundation, the Salt Lake City Deseret Morning News reports. The report was released last week during an annual meeting of the Association of Healthcare Journalists in Los Angeles (Collins, Salt Lake City Deseret Morning News, 3/17). For the report, LaVera Crawley, a medical ethics researcher at Stanford University; and Marjorie Kagawa Singer, a professor at the University of California-Los Angeles School of Public Health and the Asian American Studies Center; and colleagues analyzed 2004 death records from the California Department of Health Services and other sources. Among patients who died while in hospice care, 4% were Asian American, 6% were black, 15% were Hispanic and 74% were white (Engel, Los Angeles Times, 3/16). Researchers also found that:

• While many black and Hispanic patients desire aggressive end-of-life treatments, many private health plans, as well as Medicare, do not cover such care while a patient is in a hospice;
  
  
• Cost of care is a primary concern for Hispanics and Asian Americans;
  
  
• Blacks are concerned about finding a care provider who respects their culture; and
  
  
• Whites' top concern is pain and discomfort (Salt Lake City Deseret Morning News, 3/17).

The report calls for reforming the Medicare Hospice Benefit to include more aggressive treatments and palliative care; expanding public benefits for end-of-life care; improving bereavement services in emergency departments; and developing educational courses on ethnic and cultural aspects of pain management (Los Angeles Times, 3/16).

The report is available online.