Background: Providing excellent end-of-life care for an ever more diverse patient population can be a challenge which has been named a priority by the Institute of Medicine. Hospice is one widely available tool used to provide this care. Despite its accessibility; however, multiple studies have demonstrated that African Americans are less likely to enroll in hospice services. The nurse-patient relationship is one vital component of hospice care, presenting opportunities for interventions aimed at improving African Americans' experiences in hospice.

Purpose: The purpose of this study was to explore hospice nurses' experiences, attitudes, beliefs, and practices when caring for African American patients and their families.

Methods: A convergent parallel Mixed Methods Research design was used where qualitative interview data and quantitative data that included demographics, Motivation to Respond Without Prejudice scale, and the Implicit Association Test for race were collected and analyzed concurrently. Analysis of qualitative data were conducted with an aim of identifying themes within the interviews, followed by combining results with quantitative data.

Results: Qualitative responses resulted in three themes of how participants perceived caring for African Americans. These themes were family dynamics, mistrust of the system, and lack of hospice knowledge. Participants also suggested how to engage African American patients and families with data suggesting the importance of making a connection. Finally, general attitudes toward race were noted, represented by an acknowledgement or denial of race being a factor in their care for patients. When analyzing all of the data together a wide variety of combinations presented, although some interesting trends did appear. When combining the interview data with the survey data, one notable trend was that participants who scored a strong preference for White on the Implicit Association Test for race was the only group where all participants acknowledged differences and challenges when caring for African American patients and families.

Conclusion: This study demonstrated that hospice nurses are not immune to the complexity of racial issues, or the biases shown to be present in other areas of healthcare. Additionally, this study provided evidence to support previous research that caring for African American hospice patients can sometimes require unique considerations. Hospice nurses often feel a calling to provide excellent end-of-life care, regardless of race. When personal beliefs and biases are unexamined; however, hospice providers may unknowingly contribute to dissatisfaction, mistrust, and the underrepresentation of African Americans who use hospice.