Compasión Familiar: Culturally Competent Palliative Care

for Latinos

Module 1: Foundation

Meeting the challenge

Where vision meets reality

Learning Objectives: Module 1• Define palliative care• Understand expanded definition for your role• Define culturally competent care• Know difference between fact based and attitude/skill based

competence• Begin to understand and recognize common Latino cultural traits• See the value to your practice

Define: Palliative Care• Specialized care • people with any serious, complex illness • to improve the quality of life for both the patient and the family

• Palliative Care IS for• any age • at any stage

• Palliative care is NOT• only for End of Life• only Hospice

Palliative Care does…• work with other curative treatments• live better with the illness• provides support and relief

• "whole" person –physical, emotional, spiritual• patient and family members understand• active part in choosing options and goals• navigate

Expanding Palliative Care• Expanded Definition• A verb, not a noun• Actions • Attitudes• YOU can offer Palliative Care

Working Together

Cultural competence

Palliative Care

Patient Centere

d

DEFINE: Patient Centered Care

• The IOM (Institute of Medicine) definition:• "Providing care that is respectful of and responsive to individual

patient preferences, needs, and values, • and ensuring that patient values guide all clinical decisions.“

Truly Patient Centered?• Over 300 studies show that health information is not understood

(IOM report, 2004)• Tailor to the patient• Recognize cultural differences

DEFINE: Culturally Competent Care

Effective Work in Cross Cultural

Situations

policies

attitudes

behaviors

Every Encounter is Cross Cultural

Medical providers

Each patient

Working Together

Cultural competence

Palliative Care

Patient Centere

d

Moving Toward Cultural Competence

• Hispanic?• Latino?

Ask!

AcculturationLevel of

Acculturation

Education, Socio-economic

Occupation, Living Place

Age, Gender, Family Position

Country of Origin

Groups vs. Individuals• Diversity and commonality

• FACT BASED o Stereotypes

• Assumptions• Challenge: use knowledge about culture without losing the

individual

Two Sides of Cultural Competence

Facts

Skills

and Attitudes

Familismo • Gathering area• Identity and strength• Decision-making• Extended and deceased• Roots to home land

• Involve• Allow extra time• Patient = Family

Without Family Support

• Don’t assume there is family support• Patient Navigators• Fill in the gaps

As their Provider• Be aware of:

o key cultural issueso Information missing

Familismo

Familismo: Hierarchy

• Age • Gender

Familismo

• Ask• Welcome• Respect lines of

communication• Ask who gets, who

gives

Respeto and Dignidad• In the family and outside• Defer to authority due to: age, gender, social position, title, economic status, etc.

• Healthcare providers, and doctors especially

How Respeto Might Show• Nod to show listening

o may not mean agreeing or understanding

• Disrespectful to ask questions or concerns• Assume they have no choice

o may not actually agree

• Politeness may hide stress or pain

Personalismo• Relationship based• When patient is older than the provider…..• When provider is not known to patient or family….

• “Formal friendliness”• Senor, Senora, Dona NOT first name

alone• Good morning, good afternoon, how

do you do • Handshake

Involve in Decision-making

• Clarify when there is choice• Check for understanding

Espiritual and Fatalismo• Uncertainty is part of life• We are not in control

• Faith as strength, not excuse to give up• Faith may or may not be

religion

Power Differential• Response to Pre-test• If you are or will be a healthcare provider • If you are of the majority• If you speak English

Attitude

• Remember• Aware of imbalance even if

unspoken• Work against

Why?• What are the benefits?

Vision• Expanded definition of Palliative Care• Increased use of Palliative Care by Latinos

• For this to happen:• Increase health literacy—understanding of

Palliative Care—within Latino community• Develop a medical/social workforce ready to work

successfully with Latinos

What is Health Literacy?• Health literacy: “the degree to which individuals have the capacity

to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

• 62% of Spanish speaking Americans have limited health literacy.

• Culturally competent care raises health literacy.

Return on Investment: for Patients

• Deeper understanding• Skill to communicate across

cultures• Desire to communicate

Vision• Expanded definition of Palliative Care• Expanded use of Palliative Care by Latinos

• For this to happen:• Increase health literacy—understanding of

Palliative Care—within Latino community• Develop a medical/social workforce ready to

work successfully with Latinos

ROI: Return on Investment for YOU

• There is an established body of literature on the correlation between a practitioner’s capacity to provide culturally and linguistically competent care and improved health outcomes.

• Betancourt, Green, & Carrillo, 2002; Brach & Fraser, 2000; Flores et al., 2000; Kehoe, Melkus, & Newlin, 2003; Smedley, Stith, & Nelson, 2002.

Ultimate Goal

Culturally

Competent Care

Improved Health Outcom

es

Next Session• Culturally Inclusive ways to being a clinical relationship and elicit a

patient’s understanding of her condition• Why and how to use an interpreter• How to offer services of a patient navigator