End of Life Care in Latino Elders: It is more than a Language Barrier

Transcription

1 End of Life Care in Latino Elders: It is more than a Language Barrier Dulce Marìa Cruz-Oliver, MD Assistant Professor Saint Louis University School of Medicine May 3, 2013 American Geriatric Society Annual Meeting Grapevine, TX

2 Speaker Disclosures: Dr. Dulce M. Cruz-Oliver has disclosed that she has no relevant financial relationships. This work was supported by the Geriatric Academic Career Award (GACA) K01HP

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4 Learning Objectives Understand the effect of Latino cultural background on attitudes toward end of life care. Apply cultural sensitivity tool in end-of-life care decision making.

5 Components of palliative & hospice care Assess physical symptoms Psycho-social-cultural-spiritual support Ethical aspects of care Care of the imminently dying patient Structure and process of care Meets the needs of Latino Americans Born W, et al. Knowledge, attitudes, and beliefs about end-of-life care among innercity African Americans and Latinos. Journal of palliative medicine. 2004;7(2):

6 Definitions Culture: the customary beliefs, social forms and material traits of a racial religious or social group ( 2012 Merriam-Webster Dictionary INC. URL://i.word.com/imedical/culture) Latino or Hispanic: a member of an ethnic group that traces its roots to 20 Spanish-speaking nations from Latin America and Spain (2010 U.S. Census Bureau)

7 Epidemiology Hispanic population increased by 15.2 million (43%) between 2000 and 2010 (1) In the US 5% of elders 65 years are Latinos By 2050 there will be 14% increase (2) 1. U.S. Census Bureau Carrion IV. When do Latinos use hospice services? Social work in health care. 2010;49(3):

8 Characteristics of Latino culture 3/4 of Hispanics in the US identify as Mexican, Puerto Rican or Cuban origin (1) Mixed cultural & ethnic heritage of indigenous, European and African cultures (2) 1. U.S. Census Bureau Del Rio, N. The influence of Latino ethnocultural factors on decision making at the end of life. J Social Work in EOL & Palliative care 2010.

9 BELIEF Familismo Filial piety Respeto Personalism Fatalismo Religiosity & spirituality Latino cultural values DEFINITION Emphasis placed on family loyalty and cohesion Moral obligation of children to care for and respect elders. Dictates differential behavior toward others on the basis of person s authority, age, gender and socioeconomic status. Development of warm, personal relationship with the medical professional. A belief in fate that one s future is preordained or not under one s control. Prayer and faith in God is the major source of comfort and way to cope with symptoms and dying. Smith AK, et al. JAMA Del Rio, N. J Social Work in EOL & Palliative care 2010.

10 Challenges of Latino EOL care 1. EOL communication compromised by Cultural factors: language barrier & acculturation Low health literacy level Acculturation BAR Traditional Bicultural Assimilated 2. Lack of awareness of hospice service 3. Prohibitive cost Talamantes MA, et al. Hispanic American Elders. Hospice care and cultural diversity. Ed: Infeld DL et al Born W, et al. Knowledge, attitudes, and beliefs about EOL among inner-city African Americans & Latinos. Journal of palliative medicine

11 OVERCOMING THE CHALLENGES Literature review

12 Literature review PubMed and Ovid websites of the English and Spanish-language articles ( ) Search terms: Latino and Hispanic ethnicity linked with end of life, palliative care and hospice in elderly or elders. RESEARCH QUESTION: What evidence is available on how to deliver EOL care to Latino elders? Cruz-Oliver DM, Talamantes M, Sanchez-Reilly S.What Evidence is Available on End-of-life (EOL) Care and Latino Elders? A Literature Review. Am J Hosp Palliat Care Mar 15. [Epub ahead of print]

13 Topics Latino EOL care preferences Number, Quality of evidence General comments Latino culture 9, low Culturally based beliefs influence illness experience, decision making and care at EOL. Some mother Latin countries have integrated palliative medicine into their health care system. EOL preferences -Decision making -Advance directives -Place of death 15, medium Latinos are less likely to have advanced directives, they prefer family-decision making, avoid nursing homes and have mixed results on aggressiveness of therapy (ICU, transfusion use). Educational interventions are effective in changing Latino s attitudes toward palliative care. Hospice 9, medium Hispanics use hospice less and EOL care cost is higher, but expenditure was better explained by geography. Places with large Hispanic population have same hospice access as Whites. Prefer Spanish-speaking staff. Caregiving 5, high Irrespective of race/ethnicity, caregivers experience burden and it is improved with hospice respite program. There are some interventions proven to help caregivers of patients with dementia. TOTAL 38, medium Cruz-Oliver et al. Am J Hosp Palliat Care 2013

14 Topics Topics Latino EOL care preferences General comments Latino culture 9, low Culturally based beliefs influence illness experience, decision making and care at EOL. Some mother Hospice 9, Hispanics use hospice less and Latin countries have integrated palliative medicine into their health care system. EOL preferences -Decision preferences making -Advance directives -Decision -Place of death Number, Number, Quality Quality of of evidence evidence evidence EOL 15, medium atino culture 9, low making -Advance General General comments comments medium EOL care cost is higher, but Latinos are less likely to have expenditure was better explained Caregiving 5, high Irrespective of 15, medium Latinos are less likely to have advanced directives, advanced they prefer family-decision directives, making, they prefer avoid nursing familydecision by geography. making, based beliefs Places avoid influence nursing with large homes illness Culturally homes and have mixed results on aggressiveness of therapy (ICU, transfusion use). Educational experience, race/ethnicity, interventions are decision effective in making caregivers and Hispanic have mixed population results changing have on and Latino s same attitudes toward palliative care. experience burden and it hospice access as Whites. Prefer is improved with hospice at aggressiveness EOL. Some mother of therapy Latin (ICU, countries have integrated palliative medicine into Hospice 9, medium Hispanics use hospice less and EOL care cost is directives transfusion higher, but expenditure was better explained by their Spanish-speaking use). Educational geography. health Places care with system. staff. -Place of respite program. large Hispanic population There have same hospice access as Whites. Prefer death Spanish-speaking are some staff. interventions interventions are effective in changing Latino s attitudes toward palliative care. proven to help caregivers of patients with dementia. Caregiving 5, high Irrespective of race/ethnicity, caregivers experience burden and it is improved with hospice respite program. There are some interventions proven to help caregivers of patients with dementia.

15 Cruz-Oliver DM, Talamantes M, Sanchez-Reilly S.What Evidence is Available on End-of-life (EOL) Care and Latino Elders? A Literature Review. Am J Hosp Palliat Care Mar 15.

16 OVERCOMING THE CHALLENGES Literature review Needs assessment using focus group and experiential journal

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18 OVERCOMING THE CHALLENGES Literature review Needs assessment using focus group and experiential journal Creation of culturally sensitive tool: Video

19 Video: Don Sanchez

20 OVERCOMING THE CHALLENGES Literature review Needs assessment using focus group and experiential journal Creation of culturally sensitive tool: Video Pilot dissemination with pre/posttest

21 REFERENCES 1. Ennis SR R-VM, Albert NG. The Hispanic Population: 2010 Census Bureau. U.S. CENSUS BUREAU [cited /27/2011]; Available from: 2. Carrion IV. When do Latinos use hospice services? Studying the utilization of hospice services by Hispanics/Latinos. Social work in health care. 2010;49(3): Epub 2010/03/ Passel J TP. Who's Hispanic?. Pew Research Center; 2009 [February 6, 2012]; Available from: 4. What is Health Literacy? St. Vincent Charity Medical Center in Cleveland, OH. URL: Access August R F. Hispanic College Enrollment Spikes, Narrowing Gaps with Other Groups. Pew Research Center; 2011 [Feb 8, 2012]; Available from: 6. Hispanics Say They Have the Worst of a Bad Economy. Pew Hispanic Center 2012 [Feb 6, 2012]; Available from: 7. Wallace SP, Villa VM. Equitable health systems: cultural and structural issues for Latino elders. American journal of law & medicine. 2003;29(2-3): Epub 2003/09/ Talamantes MA, Lawler WR, Espino DV. Hispanic American elders: caregiving norms surrounding dying and the use of hospice services. The Hospice journal. 1995;10(2): Kwak J, Haley WE. Current research findings on end-of-life decision making among racially or ethnically diverse groups. The Gerontologist. 2005;45(5): Kelly AS WN, Karkisian CA. Opiniones: end of life care preferences and planning of older Latinos. Journal of the American Geriatrics Society. 2010;58: Braun UK, McCullough LB, Beyth RJ, Wray NP, Kunik ME, Morgan RO. Racial and ethnic differences in the treatment of seriously ill patients: a comparison of African- American, Caucasian and Hispanic veterans. Journal of the National Medical Association. 2008;100(9): Born W, Greiner KA, Sylvia E, Butler J, Ahluwalia JS. Knowledge, attitudes, and beliefs about end-of-life care among inner-city African Americans and Latinos. Journal of palliative medicine. 2004;7(2): Braun UK, Beyth RJ, Ford ME, McCullough LB. Voices of African American, Caucasian, and Hispanic surrogates on the burdens of end-of-life decision making. Journal of general internal medicine. 2008;23(3): Morrison RS, Zayas LH, Mulvihill M, Baskin SA, Meier DE. Barriers to completion of health care proxies: an examination of ethnic differences. Archives of internal medicine. 1998;158(22): Epub 1998/12/ Blackhall LJ, Frank G, Murphy ST, Michel V, Palmer JM, Azen SP. Ethnicity and attitudes towards life sustaining technology. Soc Sci Med. 1999;48(12): Muni S, Engelberg RA, Treece PD, Dotolo D, Curtis JR. The influence of race/ethnicity and socioeconomic status on end-of-life care in the ICU. Chest. 2011;139(5): Duffy SA, Jackson FC, Schim SM, Ronis DL, Fowler KE. Racial/ethnic preferences, sex preferences, and perceived discrimination related to end-of-life care. Journal of the American Geriatrics Society. 2006;54(1): Kreling B, Selsky C, Perret-Gentil M, Huerta EE, Mandelblatt JS. 'The worst thing about hospice is that they talk about death': contrasting hospice decisions and experience among immigrant Central and South American Latinos with US-born White, non-latino cancer caregivers. Palliative medicine. 2010;24(4): Epub 2010/05/ Carrion IV. Communicating terminal diagnoses to Hispanic patients. Palliative & supportive care. 2010;8(2): Epub 2010/03/ Gelfand DE, Balcazar H, Parzuchowski J, Lenox S. Mexicans and care for the terminally ill: family, hospice, and the church. The American journal of hospice & palliative care. 2001;18(6): Carrion IV, Park NS, Lee BS. Hospice Use Among African Americans, Asians, Hispanics, and Whites: Implications for Practice. The American journal of hospice & palliative care Volandes AE, Ariza M, Abbo ED, Paasche-Orlow M. Overcoming educational barriers for advance care planning in Latinos with video images. Journal of palliative medicine. 2008;11(5): Adams CE, et al. Hispanic access to hospice services in a predominantly Hispanic community. The American journal of hospice & palliative care. 2006;23(1): Cruz-Oliver DM, Talamantes M, Sanchez-Reilly S.What Evidence is Available on End-of-life (EOL) Care and Latino Elders? A Literature Review. Am J Hosp Palliat Care Mar 15. [Epub ahead of print]

22 Thank you for your attention! QUESTIONS?