Sociodemographic Disparities in the Use of Hospice by U.S. Nursing Home Residents: A Systematic Review.
Christine E DeForge, Hsin S Ma, Andrew W Dick and 5 others
PMID 39787275WHAT IT FOUND
Nursing home residents who were male, non-White, or in rural facilities were less likely to use hospice in studies accounting for other factors.
Evidence was old and mixed, so these findings should not be treated as proof of why use differs.
Key findings
01In studies that adjusted for other factors, male residents, Black or non-White residents, and residents of rural nursing homes generally had lower hospice use.
02No included study examined differences in hospice quality of care among nursing home residents.
03Eleven of 13 included studies analyzed data from before 2009.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies used data from before 2009, so patterns may not reflect current nursing homes, hospice practices, or regulations. Samples were often regional, state, single health system, or diagnosis-specific, not all nursing home residents. Hospice use was defined differently across studies, such as enrollment at different times before death. No included study examined differences in hospice quality of care. The review synthesized observational studies, so it shows associations rather than causes of lower hospice use. Few studies used stratified analyses or interaction terms to explain racial differences.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that male, non-White, or rural residents need less hospice or that hospice use causes better outcomes. The review found lower use in observational studies, mostly with old data, and it did not explain why use differed or measure hospice quality.