Hispanics, the fastest growing minority in the United States, often face challenges with end-of-life healthcare. The challenges are greatest for those new to this country, those who lack health insurance and those with a limited understanding of English.
To further complicate the situation U.S. healthcare providers may have an incomplete understanding of Hispanic culture. Many cultural characteristics, such as stoicism and familism, may prevent Hispanic families from seeking outside resources such as hospice services. As the number of Hispanics living in this country increases, it is vital for healthcare providers to understand and be sensitive to their cultural values.
Recently, I encountered an elderly Hispanic woman who was dying from multisystem organ failure. She and her extended family had moved to the United States from the Dominican Republic about five years ago. The family unit was strong, and the patient’s son was responsible for all decision making. After several discussions with her physicians, it was decided that the woman’s prognosis was poor. The son ultimately agreed to hospice care in their home.
The patient’s daughter did not want her mother to be informed of her poor prognosis, or the decision to use hospice services. In broken English she explained she did not want her mother to struggle like her father did after they informed him he was dying.
The physician, however, insisted that the patient be informed, since she was still conscious. A look of terror came across the daughter’s face. She began to cry and pleaded with the physician not to tell her mother.
A common theme in Hispanic culture is the desire to shield the sick family member from knowing of a dreaded diagnosis or poor prognosis. In these families, it is often the eldest male, not the patient, who is responsible for decision-making. Healthcare providers should be sensitive to this cultural difference and understand that the family usually has the best interest of the patient in mind.
Relatives in Hispanic families are often highly involved with caring for sick family members. They accompany loved ones to appointments, stay with the patient in hospital rooms and may move temporarily to be closer to the ill person. They are nearly always willing to assist with personal care. Healthcare providers should acknowledge this dynamic and make accommodations for family members. Extra chairs or cots can be placed in rooms, and family members should be asked if they want to assist with personal care.
The elderly Hispanic woman was never informed of her prognosis by the healthcare team. She and her family returned home with hospice. Several of her family members stayed with her and assisted in her care. She passed away peacefully at home four days later.
Jessica Swanson, FNP, MSN, is in the DNP program at the University of Central Florida College of Nursing in Orlando, where Julee Waldrop, DNP, FNP, PNP, is the director of the MSN-DNP program and an associate professor.
- Kemp C. Culture and the end of life. Hispanic cultures (focus on Mexican Americans). Journal Of Hospice & Palliative Nursing, 2001;3(1), 29-33.
- Mitchell B & Mitchell L. Review of the literature on cultural competence and end-of-life treatment decisions: the role of the hospitalist. Journal Of The National Medical Association. 2009;101(9), 920-926.
- Shrank W et al. Focus group findings about the influence of culture on communication preferences in end-of-life care. Journal Of General Internal Medicine. 2005;20(8), 703-709.