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End of life hospice services have consistently been underused by African Americans. This disproportionate use of hospice has contributed to poor quality of life and a lack of cost-effective care for patients with terminal illness. Driven by the theory of reasoned action, the purpose of this quantitative study was to test associations between African Americans' perceptions of hospice, decisions to use hospice, and religiosity. A convenience sample of 154 African American adults was surveyed online. The survey instrument combined the AARP End of Life survey, Perception of Hospice survey, and the Religiousness Measure survey. The results of a multiple linear regression showed a significant relationship between religiosity and perception of hospice where those who reported a higher level of religiosity had a more favorable perception of hospice (B = .174, p = .041), whereas there was no support of a relationship in which religiosity was a predictor of intent to use hospice (B = -.019, p = .816). Findings also showed the more positive the perception of hospice the lower the rate of intent to use hospice (B = -.181, p = .002). This research could benefit health care providers, researchers, and community members by increasing public awareness and education of hospice. Focus on the underuse of hospice by African Americans may promote positive social change through discussion within communities and hospice agencies about the barriers to service; these results may also foster implementation of interventions and initiatives that improve service to underserved populations. Such efforts could improve quality of life for individuals, their families, and communities.