Underutilization of Hospice Care in Older Black Adults

Knowledge of and Attitudes Toward Hospice, Decision-making Around Hospice in Older Black Adults

This study will sample older Black adults to test their knowledge and opinions of hospice.

Study Overview

• Status: Active, not recruiting
• Conditions: Aging; Attitude; Decision Aid; Knowledge; Hospice Care; Decision-Making
• Intervention / Treatment: Other: IDECIDE-HOSPICE

Detailed Description

Short stays in hospice strain the Medicare system. Black adults over age 65 are one of the fastest growing groups in the US. Despite greater disease burden than their White peers, older Black adults are less likely to enroll in hospice. Misconceptions about hospice and mistrust may contribute to this disparity. The research will seek to understand older Black adults' decision-making processes around hospice. The PtDA is a tool to assist in this decision-making process. The influence of this tool will be measured as well. The sample of older Black adults will represent the national population. The research will explore various subgroups, which previous research has been unable to address. This study will use four validated survey batteries. About 200 of the 400 participants will also review the decision aid. These adults will complete a second survey. About 20 of these adults will also complete an interview about the decision aid. Through the surveys and interviews, this research will explore barriers to hospice usage for older Black adults.

• Study Type: Interventional
• Enrollment (Actual): 400
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Aurora, Colorado, United States, 80045
      • University of Colorado Denver | Anschutz Medical Campus

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Identifies as Black or African American
• Can read and write English

Exclusion Criteria:

• Unable to read/write English
• Have a cognitive impairment that prevents them from providing informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; 200 participants reviewed the PtDA decision tool for education on hospice care and subsequently completed a second survey which was identical to the first.	Other: IDECIDE-HOSPICE; 12-pg educational booklet detailing information about hospice including what hospice is, why someone would use hospice, who pays for hospice, and where hospice services are delivered; Other Names: PtDA
Other: Interview; 20 of the 200 Intervention participants will complete an interview using qualitative methods surrounding the topic of hospice care and the PtDA.	Other: IDECIDE-HOSPICE; 12-pg educational booklet detailing information about hospice including what hospice is, why someone would use hospice, who pays for hospice, and where hospice services are delivered; Other Names: PtDA
No Intervention: Control; 200 of the 400 participants completed two identical surveys one month apart but did NOT review the PtDA decision tool prior to completing the second survey timepoint. Instead, these participants reviewed an 8-page attention control activity booklet. These participants are used as a control group in assessing any change in knowledge or opinions of hospice after the intervention group reviewed the PtDA.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospice Knowledge	assessed using 23-item hospice knowledge survey	June 2023 through September 2023
Hospice Beliefs and Attitudes	measured using 8-item Hospice Beliefs and Attitudes Scale (HBAS)	June 2023 through September 2023
Self-Efficacy	assessed using 11-item Decision Self-Efficacy Scale (DSE)	June 2023 through September 2023

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Medical Mistrust	measured using 17-item Medical Mistrust Index (MMI)	June 2023 through September 2023

Collaborators and Investigators

• Sponsor: University of Colorado, Denver
• Investigators: Principal Investigator: Channing E Tate, PhD, MPH, University of Colorado School of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): June 2, 2023
• Primary Completion (Estimated): September 30, 2024
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: October 31, 2023
• First Submitted That Met QC Criteria: May 7, 2024
• First Posted (Actual): May 9, 2024

Study Record Updates

• Last Update Posted (Actual): May 9, 2024
• Last Update Submitted That Met QC Criteria: May 7, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: 23-0899

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No