Black Medicare beneficiaries are far less likely to accept hospice care or prepare advanced care directives than their white counterparts, according to a new report from Kaiser Health News.

Researchers found that a third of eligible black beneficiaries enroll in hospice, compared to half of white beneficiaries. Meanwhile, about 40% of whites over 70 draw up legal documents related to future care, compared to just 16% of blacks.

The findings may reflect differences in access to healthcare, insurance coverage and the number of patients living in poverty.

“You have people who’ve had a difficult time getting access to care throughout their lifetimes, and then you have a physician who’s saying, ‘I think that we need to transition your mother, father, grandmother to comfort care or palliative care,’” Maisha Robinson, M.D., a neurologist and palliative medicine physician at the Mayo Clinic in Jacksonville, FL, told Kaiser. “People are skeptical of that.”

A Medicare proposal to pay physicians for end-of-life discussions could deepen the divide. Minorities are expected to comprise 42% of those over age 65 by 2050.