As efforts build to improve end-of-life care in Pennsylvania, one aspect receiving special attention next week is the shortfall in hospice and palliative care usage by minorities.

Dr. Richard Payne, director of Duke University's Institute on Care at the End of Life, will give a free public presentation at Hillman Cancer Center at 5 p.m. Monday discussing disparities in late-life treatment of racial and ethnic minorities compared to other groups.

Dr. Payne, considered an expert in pain relief, on Tuesday will address a Coalition for Quality at the End of Life committee working on late-life issues for underserved populations. The coalition is a volunteer regional group made up of physicians, hospice providers, health care executives, clergy, lawyers and others trying to promote alternatives to use of intensive care techniques on terminally ill patients.

A comprehensive report from a statewide task force last month stressed that Pennsylvanians would benefit from more use of hospice and comfort measures. It noted special emphasis needed to be given to certain groups -- such as racial minorities and people with disabilities -- that used them less than the rest of the population.

Dr. Payne's visit is a first step in efforts by the local coalition to try to promote the issue among both minority groups and the health professionals who treat them, said the Rev. John Welch, co-chair of the coalition committee on underserved populations.

Mr. Welch, vice president of student services for Pittsburgh Theological Seminary, said the health care community may have a perception that black patients don't want to use palliative or hospice care, while the patients might simply be ignoring it because they're unaware of their options.

Mr. Welch, who is black, said low-income groups in general and African-Americans in particular feel little trust for physicians historically, because of disparities in their medical treatment. He believes it's up to the medical profession to overcome that, by better communication.

"I think everyone, whether African-American, low-income or affluent, has some reticence in any discussion of end-of-life issues. They just sound so final," Mr. Welch said. If minority populations receive more education, some still might not opt for medical choices that emphasis comfort over life-prolonging techniques, but he believes more would do so than today.

"All you can do is set the table," he said. "Whether they choose to eat is up to them."

The National Hospice and Palliative Care Organization reported that of the 1.2 million patients receiving hospice services in 2005, 82 percent were white, 7 percent were black and the rest were of other races or of a mix.

One large community-based hospice agency in the Pittsburgh region had African-Americans making up just 4 percent of its patients, according to a statement from the Coalition for Quality at the End of Life. The coalition also noted that many people with physical or mental disabilities worry that their lives are viewed as less valuable or as having lower quality.

"In this context, palliative care can appear especially threatening, despite beneficial pain relief and symptom control, because it is often proposed as an alternative to aggressive life-sustaining treatment near the end of life," the statement said.

Mr. Welch said the committee will meet with various representatives of minority and disabilities groups, as well as the health care community, to work on the issue.

Those interested in attending Dr. Payne's lecture Monday should register by calling 412-623-3651.