Integrative Review of the Literature on Hispanics and Hospice

Abstract

The provision of optimal end-of-life care to Hispanics receiving hospice care requires familiarity with hospice-specific variables. For example, a preference for nondisclosure of terminal prognosis in some Hispanics is incongruous with traditional hospice practice. In addition, the Spanish word for hospice, "hospicio," has negative connotations about abandonment of loved ones. Added to cultural considerations are socioeconomic considerations. Many marginalized Hispanic individuals may experience distinct challenges when enrolling in hospice due to socioeconomic hardships relating to poverty, citizenship, and lack of insurance. This systematic integrative review examines the research literature on Hispanics and hospice to report on the state of the science for this topic. Reviewed articles were identified systematically using computer research databases and inclusion and exclusion criteria. Of the 21 reviewed articles, many are survey and low-inference qualitative designs with limited validity and trustworthiness. Most survey instruments were not validated for Spanish language or Hispanic culture. None of the qualitative studies included theoretical sampling or follow-up interviews. Few study designs considered heterogeneity within the Hispanic population. Interpreting results cautiously, there is evidence that some Hispanics find some satisfaction with hospice care in spite of cultural incongruities and socioeconomic challenges. Future research calls for intervention studies and high-inference qualitative designs to gain insight into hospice experiences and what constitutes quality hospice care from the perspectives of Hispanic subgroups. Assessing quality and designing interventions for these end-of-life cultural and socioeconomic issues will improve end-of-life care and facilitate the hospice philosophy of promoting emotional growth at end of life.

Improving End-of-Life Care for Diverse Populations: Communication, Competency, and System Supports

“…It is sometimes assumed that racial or ethnic minority groups do not prefer direct communication about difficult health-related news, but our findings show diversity within racial and ethnic groups. 21 -23 One African American participant explained, “I ask point blank, ‘Is he going to die?’ ‘Is she going to die?’ But they don’t tell you that. […] The relationship with the doctor is very important, you know, that you want to be able to talk freely with the person and get good care answers.” While direct communication from providers was a strong theme across all groups, the nature and amount of medical information a participant desired varied widely by individual, regardless of race/ethnicity.…”

“…First, in contrast to a common assumption that members of racial and ethnic minority groups do not prefer direct communication about their illness, we found that participants in all groups expressed a preference for open, honest communication. 21 -23 That is not to say that all participants agreed with this or that these participants represented all people from these groups. However, it does show that there is diversity within racial and ethnic groups, and research and practice should acknowledge that diversity within groups.…”

“…It is sometimes assumed that racial or ethnic minority groups do not prefer direct communication about difficult health-related news, but our findings show diversity within racial and ethnic groups. [21][22][23] One African American participant explained, "I ask point blank, 'Is he going to die?' 'Is she going to die?'…”

A Shot at Inclusion: Reconsidering Categorical Exclusion of Hospice Patients from COVID Vaccine Allocation

“…34−36 The patient's son's reference to previous culturally incongruent interactions warrants consideration of the role for improved care and proactive communication (in the family's chosen language) partnered with cultural humility. 37 Ms. B's son has experienced care inequities in the past which warrant a trauma-informed compassionate consideration to the family's current hospice experience. 38,39 Hospice Goals.…”

On Board

“…2,4,5 The structure and organization of hospice service delivery may contribute to these problematic patterns of service utilization, including issues with language interpretation and cultural insensitivity among hospice providers. 6,7 These issues have prompted calls for more culturally competent care for people nearing the end of life. 8 There are more than 6.5 million adults in the United States with heart failure and this population represents a growing share of hospice patients overall.…”