Racial differences in hospice revocation to pursue aggressive care

Area of Science:

• Palliative Care
• Health Disparities
• End-of-Life Care

Background:

• Hospice care offers supportive services for terminally ill patients.
• Some patients withdraw from hospice to pursue life-prolonging therapies.
• African American patients may have a higher preference for life-sustaining treatments, potentially leading to hospice withdrawal.

Purpose of the Study:

• To investigate racial differences in hospice revocation for aggressive care.
• To examine the association between race and the decision to leave hospice for life-prolonging therapies.

Main Methods:

• Secondary data analysis of hospice enrollees (1999-2003).
• Logistic regression used to assess race and discharge disposition (hospice revocation vs. other).
• Cox proportional hazards model analyzed 1-year survival post-revocation in a Florida subgroup.

Main Results:

• 2.8% of patients revoked hospice for aggressive care; African Americans revoked at higher rates (4.5% vs. 2.5%).
• African American patients showed 70% higher odds of leaving hospice for life-prolonging therapies (OR, 1.70).
• 48.4% of patients who revoked hospice for aggressive care were alive at 1 year.

Conclusions:

• African American patients are significantly more likely to revoke hospice to pursue life-prolonging treatments.
• Healthcare models integrating curative and palliative care may better suit African American patients and improve continuity of care.