Two interventions have consistently been shown to help patients live their final days in accordance with their wishes: earlier conversations about their goals and greater use of palliative care services, which emphasize symptom control and greater psychological and spiritual well-being — and which recognize that longer survival is only part of what patients want.

Patients who engage in advance care planning are less likely to die in the hospital or to receive futile intensive care. Family members have fewer concerns and experience less emotional trauma if they have the opportunity to talk about their loved one’s wishes. And earlier access to palliative care has consistently been linked to fewer symptoms, less distress, better quality of life — and sometimes longer lives.

We’ve made significant progress in recent years: The availability of palliative care services has increased 150 percent over the past decade, and compared with patients in other developed countries, older Americans with cancer are now the least likely to die in a hospital (22 percent versus up to 51 percent). But not everyone has benefited from the palliative care movement: Large disparities remain by geography, race and type of illness.

Ninety percent of hospitals with more than 300 beds now have a palliative care program, but only 56 percent of smaller hospitals do. Patients treated at for-profit and public safety net hospitals (known for taking in those who have no insurance) are much less likely than those in nonprofit hospitals to have access to palliative care.

Many of the palliative care programs that do exist are underfunded and understaffed. And the availability of services remains uneven across the United States: Nearly 90 percent of hospitals in New England have palliative care services compared with about 40 percent in the South. According to the Center to Advance Palliative Care, essentially all hospitals in Vermont, New Hampshire and Montana have a palliative care team, but only a third in Alabama, Arkansas and Mississippi do.

It’s also clear that well-documented health disparities for racial and ethnic minorities persist through death. Minority patients are more likely to be hospitalized and receive aggressive care during their last six months, research shows, and are more likely to die in the hospital.

They’re also less likely to have access to palliative care or use hospice: Among Medicare patients who die, nearly half of whites use hospice compared with one-third of African-Americans and 28 percent of Asian-Americans, studies show. Family members of African-Americans are generally less satisfied with the quality of care their loved ones receive, and report more concerns about end-of-life communication.