Predictors of Preference for Hospice Care Among Diverse Older Adults

John G. Cagle, Michael A. LaMantia, Sharon W. Williams, Jolynn Pek, Lloyd J. Edwards

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)574-584
Number of pages11
JournalAmerican Journal of Hospice and Palliative Medicine
Issue number6
StatePublished - Jul 1 2016


  • attitudes
  • disparities
  • hospice
  • older adults
  • survey research
  • treatment preferences

ASJC Scopus subject areas

  • Medicine(all)

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