Concurrent Care and Equity: Addressing Palliative Care Gaps for African American Men in Rural Communities with a Serious Respiratory Illness

Abstract

Hospice and palliative care are often hard to access for African Americans (AA) living in rural areas with serious respiratory illnesses. These services can improve symptoms, quality of life, and support for caregivers, but barriers remain. Under the Medicare Hospice Benefit, patients must stop curative or life-sustaining treatments for their terminal illness, which limits options for concurrent care. This is a major challenge for AA men, whose average life expectancy is 67.8 years—about 10 years shorter than the national average. They also experience more care transitions in the last 6 months of life compared to White and Hispanic patients. These frequent transitions show how fragmented the health system is and how it often fails AA families. Using intersectionality and a vignette, this paper explores how overlapping factors—lived experience as AA man, rural location, and serious illness—affect access to palliative care. The discussion ends with recommendations for clinical practice and public policy to reduce inequities and improve care.