title: Predictors of Preference for Hospice Care Among Diverse Older Adults.
abstract: The purpose of this study was to identify predictors of preference for hospice care and explore whether the effect of these predictors on preference for hospice care were moderated by race.
  
  
  METHODS
  An analysis of the North Carolina AARP End of Life Survey (N = 3035) was conducted using multinomial logistic modeling to identify predictors of preference for hospice care. Response options included yes, no, or don't know.
  
  
  RESULTS
  Fewer black respondents reported a preference for hospice (63.8% vs 79.2% for white respondents, P < .001). While the proportion of black and white respondents expressing a clear preference against hospice was nearly equal (4.5% and 4.0%, respectively), black individuals were nearly twice as likely to report a preference of "don't know" (31.5% vs 16.8%). Gender, race, age, income, knowledge of Medicare coverage of hospice, presence of an advance directive, end-of-life care concerns, and religiosity/spirituality predicted hospice care preference. Religiosity/spirituality however, was moderated by race. Race interacted with religiosity/spirituality in predicting hospice care preference such that religiosity/spirituality promoted hospice care preference among White respondents, but not black respondents.
  
  
  CONCLUSIONS
  Uncertainties about hospice among African Americans may contribute to disparities in utilization. Efforts to improve access to hospice should consider pre-existing preferences for end-of-life care and account for the complex demographic, social, and cultural factors that help shape these preferences.
authors.affiliation: School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA jcagle@ssw.umaryland.edu.
authors.forename: John G
authors.initials: JG
authors.lastname: Cagle
authors.affiliation: Indiana University Center for Aging Research and Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: LaMantia
authors.affiliation: Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Sharon W
authors.initials: SW
authors.lastname: Williams
authors.affiliation: Department of Psychology, York University, Toronto, Canada.
authors.forename: Jolynn
authors.initials: J
authors.lastname: Pek
authors.affiliation: Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Lloyd J
authors.initials: LJ
authors.lastname: Edwards
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D012067:Religion; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data*
keywords: attitudes; disparities; hospice; older adults; survey research; treatment preferences