As racial and ethnic disparities in hospice utilization persist across the United States, hospice providers and palliative care researchers are calling for a more deliberate integration of culturally responsive and trauma-informed approaches — practices they say are essential to ensuring dignified end-of-life care reaches all communities equally.
The call to action, detailed by Hospice News in June 2026, reflects a growing consensus that the hospice sector must move beyond one-size-fits-all cultural competence training and actively address how historical trauma shapes end-of-life care decision-making in marginalized communities.
Persistent Gaps in Hospice Access
Racial and ethnic minorities are significantly less likely than white patients to enroll in hospice care and, when they do enroll, are more likely to experience lower-quality services, according to research published in multiple peer-reviewed journals. Black patients in particular are significantly less likely to use hospice services compared to white patients, even after adjusting for clinical and demographic factors.
Barriers are systemic and layered. Researchers point to late referrals from providers, cultural and religious beliefs around death and illness, widespread misinformation about hospice eligibility, and a deep-seated mistrust of the healthcare system rooted in documented histories of institutional harm. The legacy of the Tuskegee Syphilis Study continues to shape African American communities’ relationship with medical institutions, according to researchers writing in the Annals of Palliative Medicine.
Geographic and language barriers compound the problem, particularly for Asian American and Latino communities where hospice utilization trails that of white patients by significant margins. A 2025 scoping review published in Palliative Medicine found that late referrals from physicians, lack of culturally adapted communication, and family-centered decision-making norms — often misread as resistance by providers — are among the primary drivers of underutilization in Asian American communities.
Trauma-Informed Care as a Clinical Framework
Trauma-informed care, as defined by the Substance Abuse and Mental Health Services Administration, is built on six principles: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, and explicit attention to historical, cultural and gendered contexts. Applied to hospice settings, clinicians must recognize that patients from historically marginalized groups may carry both personal and intergenerational trauma into end-of-life conversations.
For communities that have experienced colonization, slavery, systemic racism, or documented medical exploitation, distrust of healthcare systems is not simply a psychological barrier — it is a rational response to historic harm. Effective hospice care, experts argue, requires acknowledging that history explicitly and building trust through culturally grounded, consistent practice.
“Palliative care remains grounded in White, Christian, middle-class values,” the Hospice and Palliative Nurses Association stated in its 2023–2026 Research Agenda, which named equitable palliative care its top research priority. “This creates structural barriers for marginalized communities.” The association called for eliminating structural vulnerabilities that limit access and for developing cultural humility practices among healthcare professionals — the recognition that providers must defer to patients’ lived experiences rather than assume cultural competence through training alone.
Training Gaps Persist Across Leadership Levels
A national survey of hospice organizations found that 73 percent offered cultural competence training for staff — but the numbers reveal significant disparities by role. While more than 90 percent of nurses, social workers, and chaplains completed such training, only 63 percent of medical directors and 23 percent of board members did the same.
Most trainings ran approximately one hour and were delivered via webinar or lecture, raising questions about depth and long-term behavior change. Nearly 30 percent of hospices reported no mechanism to assess whether training produced measurable improvements in care.
Researchers have called for more immersive, longitudinal education that moves beyond cultural awareness into genuine cultural humility — including training on implicit bias, structural racism, and the specific historical traumas experienced by communities providers serve.
Research and Clinical Initiatives Expanding
Efforts to address these disparities are moving from research into clinical practice. The University of Colorado is conducting an active clinical trial investigating knowledge of and attitudes toward hospice among older Black adults, with completion targeted for 2026. The study seeks to identify specific decision-making factors driving lower enrollment rates and test educational interventions designed for that community.
The HPNA research agenda calls for community-based participatory research models — in which patients, families, and community leaders are equal partners in shaping care protocols, not simply subjects of study. Such approaches have shown promise in building trust with communities historically excluded from or harmed by medical research.
Why This Matters for Home Care
For families choosing to provide care at home, culturally responsive and trauma-informed practices are not abstract clinical frameworks — they determine whether care recipients feel seen, safe, and respected in their most vulnerable moments. Families supporting a loved one at home have the unique advantage of providing care in a familiar, dignity-preserving environment. For those setting up a home care space that meets both medical and comfort needs, SonderCare’s home hospital beds are designed to support clinical-grade care without sacrificing the warmth of home — a foundation any care approach, culturally responsive or otherwise, depends on.
