Do Hispanics prefer to be full code at the end of life? The impact of palliative care consults on clarifying code status preferences and hospice referrals in Spanish-speaking patients

Abstract

Background Hispanics often have disparities at the end of life. They are more likely to die full code and less likely to have discussions regarding prognosis and do not resuscitate (DNR)/do not intubate (DNI), despite studies showing Hispanic values comfort over the extension of life. Barriers to patient-centered care include language,socioeconomic status and health literacy. Context We evaluated the impact of palliative care (PC) consults on the change of code status and hospice referrals, comparing seriously ill Hispanic and non-Hispanic white patients. Method A retrospective cohort study of all white and Hispanic patients referred to the PC service of a county hospital from 2006 to 2012. We evaluated ethnicity, language, code status at admission and after PC consult, and hospice discharge. Chi-squared tests were used to analyze characteristics among three groups: non-Hispanic white, English-speaking Hispanic, and Spanish-speaking Hispanic patients. Results Of 925 patients, 511 (55%) were non-Hispanic white, 208 (23%) were English-speaking Hispanic, and 206 (22%) were Spanish-speaking Hispanic patients. On admission, there was no statistically significant difference in code status among the three groups (57%, 64%, and 59% were full code, respectively, p = 0.5). After PC consults, Spanish-speaking Hispanic patients were more likely to change their code status to DNR/DNI when compared with non-Hispanic white and English-speaking Hispanic patients (44% vs. 32% vs. 28%, p = 0.05). Spanish-speaking Hispanic patients were more likely to be discharged to hospice when compared with English-speaking Hispanics and non-Hispanic whites (33%, 29%, and 23%, respectively, p = 0.04). Significance of results Spanish-speaking Hispanic patients were more likely to change from full code to DNR/DNI compared with non-Hispanic white and English-speaking Hispanic patients, despite similar code status preferences on admission. They were also more likely to be discharged to hospice. PC consults may play an important role in helping patients to align their care with their values and may prevent unwanted aggressive interventions at the end of life.

Full Code to Do-Not-Resuscitate: Culturally Adapted Palliative Care Consultations and Code Status Change Among Seriously Ill Hispanic Patients

“…Our findings are in agreement with the recent publication by Kawai et al 33 showing that Spanish-speaking Hispanic patients in San Jose (CA) were more likely to change code status to DNR/DNI and also more likely to be discharged to hospice when compared with English-speaking Hispanic and non-Hispanic whites. Since in both cases the finding is somewhat at odds with previous published studies, 1,3,4,[5][6][7][8] a brief discussion of commonalities and differences between them is in order.…”

“…34 In our case, since the Hospital system itself is Catholic faith based, there was a strong sense of affirmation and it was the priest who took charge of signing and notarizing the DNR orders. In both our and Kawai’s research, 33 the involvement of a priest likely played a critical role in the high rates of switch to DNR.…”

Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study

“…Our study also supports other studies that show that perceived "blunt" discussions of death and cultural differences in caring for family members impact rejection of hospice services. [36][37][38] The recurrent references to "home" as a sacred space provides new insights into the possibility that offering patients the option to go home to die might be welcomed, if communicated in a culturally sensitive way.…”