['This study explored the reasons for low levels of hospice participation by African Americans.', 'Data about attitudes toward dying and death, advanced directives, and barriers to using hospice services were collected from 314 adults attending 11 diversely populated churches in North Carolina.', 'Almost all participants indicated (91%) willingness to use hospice, particularly if the hospice team were diverse (77%). Most are without a living will (72%) or health care power of attorney (81%); approximately half (54%) have shared final care wishes.'] Do barriers to hospice use and palliative care services use by African American adults?