Pastor-Endorsed Hospice Education Increases Willingness to Accept Hospice Among African American Congregants in Rural North Carolina

Abstract

Despite comprising 19% of Rockingham County’s population, African Americans represent only 12% of hospice users, reflecting broader disparities in end-of-life care. Cultural mistrust, spiritual concerns, and knowledge gaps contribute to underutilization, and few interventions leverage faith leaders’ influence. This preliminary quality improvement project evaluated a culturally tailored, pastor-endorsed hospice education intervention in two African American Baptist churches (n = 49). Guided by humanistic nursing theory, pastors used the African American Outreach Guide for End-of-Life Care to dispel myths and explain hospice services. Willingness to accept hospice (AARP End of Life Survey) increased from 60.4% to 93.6% (51.7% relative increase), and uncertainty decreased from 39.6% to 6.4% (84.2% reduction). Medicare hospice coverage knowledge increased from 29.2% to 89.8% (214% relative increase). A paired t-test among matched pairs (n = 46) showed a meaningful pre–post change (t = 4.899, P < .001) with a medium-to-large effect (d = 0.72). The preliminary quality improvement project suggests pastor-endorsed education delivered in faith settings may improve hospice acceptance and advancing health equity.