: Within the last three decades, hospice care has emerged as an important form of end-of-life care in the United States. Hospice care provides an alternative to traditional, curative medicine by offering dying patients palliation from physical, emotional and spiritual suffering. In the last decade, hospice utilization in the United States has increased rapidly. In addition, the type of patient entering hospice care has changed. Until recently, the majority of patients using hospice care were older, middle class, and non-Hispanic Whites with a cancer diagnosis. Now, as the older adult population becomes more ethnically diverse and advances continue to be made in life-prolonging technologies, the profile of the typical hospice patient is also changing. ? ? There is a growing concern in the hospice community that members of racial and ethnic minority groups are underutilizing hospice care in comparison to Non-Hispanic Whites. It is important to: 1) determine if disparities in hospice utilization exist among different racial and ethnic groups; and 2) explain why these disparities exist. The purpose of this study is to examine variation in the use of hospice care by patient race and ethnicity. ? ? The specific aims of this proposal are to: 1) investigate differences in the use of hospice care by patient race and ethnicity; 2) examine racial and ethnic differences in hospice use by type of cancer diagnosis; 3) assess racial and ethnic differences in the use of hospice care by geographic location; and ? 4) examine variation in the use of hospice care over time by patient race and ethnicity. ? ? Data from the linked SEER (Surveillance, Epidemiology and End Results)-Medicare database will be used to study hospice care utilization in subjects diagnosed with breast, lung, colorectal or prostate cancer from 1986 to 1996 at age 65 and over who died from 1991 to 1999. The SEER population covers approximately 14% of the United States. Logistic regression analyses and chi-square analyses will be used to achieve the study goals. The findings will contribute to the existing knowledge of hospice care utilization among four racial and ethnic groups (Non-Hispanic Whites, African Americans, Hispanics and Asians and Pacific Islanders) in the United States. ? ?
