New Jersey Study Reveals Statewide Racial Disparities in Hospice Referrals

Race and socioeconomic status continue to deepen disparities in access to end-of-life care across the country.

Recent research from Rutgers University-New Brunswick in New Jersey has revealed gaps in hospice referrals and palliative care consultations among underserved patient populations in the state.

African-American and Hispanic patients had “significantly lower odds” of receiving a hospice referral or an inpatient palliative care consultation compared to Caucasians, according to a recent study published in the Journal of Hospice & Palliative Care Nursing.

The research spanned two studies that examined the occurrence of end-of-life care referrals during 2018 among 28,697 hospitalized patients diagnosed with metastatic cancer in the Garden State.

Additionally, patients with a primary language other than English were increasingly less likely to receive a hospice referral, as well as those who had a lower middle-income economic status.

Educating patients and health care workers can lead to diminished disparities in quality and access to end-of-life care, according to researcher Elissa Kozlov, an instructor at the Rutgers School of Public Health’s Department of Health Behavior, Society and Policy.

“New Jersey is a diverse community, and our clinicians must take into consideration language barriers and potential translation obstacles that can lead to misinterpretations of symptoms,” Kozlov said in local news interview. “When we remove these obstacles and educate our workforce, we are able to work towards ensuring that we are providing the best quality of life for patients.”

Researchers at the Rutgers School of Public Health and Rutgers School of Nursing assessed patient demographics and clinical symptoms that impacted this trend from data included in the New Jersey State Inpatient Database. Patients who reported higher incidences of pain symptoms and depression were more likely to receive a hospice referral or palliative care consultation, though researchers indicated cultural and language barriers were factors.

Black and Hispanic patients and those whose primary language was not English were also less likely to be diagnosed with depression, which can be a common symptom that signals consultations and referrals.

“Diversity in population can yield diverse presentations of symptoms,” Kozlov said. “Depression symptoms can appear differently in Black and Latinx as compared to white individuals.”

Racial divides have proliferated access to hospice services nationwide.

Roughly 82% of Medicare decedents in 2018 were Caucasian, according to NHPCO. Comparatively, that year, slightly more than 8% were African-American; 6.7% were Hispanic; 1.8% were Asian; and only 0.4% were Native American.

Health care disparities affecting people of color have persisted for decades, rising to heightened levels of concern amid the pandemic and increased civil unrest in the last few years.

Hospices have turned their focus on improving access to care among underserved populations and addressing diversity and equity in their organizations. Some have ramped up diversity, equity and inclusion initiatives in their staff training.

The majority of hospice providers who participated in a 2020 study published in the BMJ Supportive & Palliative Care Journal indicated that racial, ethnic and minority disparities were an impetus for establishing greater diversity initiatives within their organizations.

However, hospices have much room to grow when it comes to educating their workforce and implementing standardized policies that bridge racial gaps in end-of-life care, according to Kozlov.

“We must create valid, reliable and culturally relevant measures to assess patients’ needs, because they do impact the treatment options and care they receive,” said Kozlov.