Use of Role Model Stories to Overcome Barriers to Hospice among African Americans

Objectives: To test a brochure comprising hospice patient role model stories aimed at improving attitudes and knowledge of hospice among older African Americans. Design: Pre-post community-based study. Setting: Community-based organizations including senior centers, community exercise programs, churches, and senior care management services in greater Los Angeles area. Participants: Seventy-one African Americans aged 65 and older. Intervention: Hospice brochure containing theoretically driven role model stories portraying African Americans' experience with hospice, their initial attitudes and beliefs about hospice, factors influencing their enrollment in the program, and outcomes following enrollment. Measurements: Change from baseline in attitudes toward, knowledge of, and intentions to enroll in hospice. Results: Mean knowledge scores (range, 0-9) increased from 5.76 (standard deviation [SD] = 2.12) at pretest to 6.95 (SD = 1.90) at posttest (t = -6.14, p < 0.001). Average attitude toward hospice (range, 12-72) improved 12.5% from 41.16 (SD = 5.20) to 46.29 (SD = 5.45) (t = -7.52, p < 0.001). Intentions to enroll a family member in hospice increased from 84.5% to 92.9% (p = 0.002) and intentions to seek hospice care for themselves increased from 83.1% to 95.8% (p < 0.001). Conclusion: This small pre-post pilot study found that exposure to a hospice brochure containing theoretically driven, culturally parallel, role model stories was effective in improving knowledge of and attitudes toward hospice as well as intentions to enroll a family member or self in hospice care. Further study is needed to determine the impact of using this brochure within a clinical setting.