Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-24T01:44:25.781Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  14 July 2020

Fernando Kawai Open the ORCID record for Fernando Kawai [Opens in a new window] ,
Cynthia X. Pan ,
John Zaravinos ,
Min Min Maw  and
Gary Lee
Fernando Kawai*
Affiliation:
Department of Medicine, Weill Cornell Medical College Flushing, New York Presbyterian Queens, New York, NY
Cynthia X. Pan
Affiliation:
Department of Medicine, Weill Cornell Medical College Flushing, New York Presbyterian Queens, New York, NY
John Zaravinos
Affiliation:
VITAS Healthcare Corp Hospice, Miami, FL
Min Min Maw
Affiliation:
Geisinger-Lewistown Hospital, Lewistown, PA
Gary Lee
Affiliation:
Suncrest Hospice Freemont, Fremont, CA
*
Author for correspondence: Fernando Kawai, Department of Medicine, New York Presbyterian Queens, 56-45 Main St Flushing, NY 11035, USA. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Code statusHispanicHospiceLatino
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 2 , April 2021 , pp. 193 - 197
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Baker, DW, Parker, RM, Williams, MV, et al. (1996) The healthcare experience with patients with low literacy. Archive of Family Medicine 5(6), 329–334.CrossRefGoogle ScholarPubMed
Balboni, TA, Vanderwerker, LC, Block, SD, et al. (2007) Religiousness and spiritual support among advanced cancer patients and associations with end of life treatment preferences and quality of life. Journal of Clinical Oncology 25(5), 555–560.CrossRefGoogle ScholarPubMed
Blackhall, LJ, Frank, G, Murphy, ST, et al. (1999) Ethnicity and attitutes toward life-sustaining technology. Social Science Medicine 48, 1779–1789.CrossRefGoogle Scholar
Braun, UK, Beyth, RJ, Ford, ME, et al. (2008) Voices of African American, Caucasian, and Hispanic surrogates on the burdens of end of life decision-making. Journal of General Internal Medicine 23(3), 267–274.CrossRefGoogle ScholarPubMed
California Catholic Conference (2019) Frequently Asked Questions about End-of-Life Care. Available at: https://www.cacatholic.org/teachings/embracing-our-dying/frequently-asked-questions-about-end-life-care (accessed 8 January 2019).Google Scholar
Castro, CM, Wilson, C, Wang, F, et al. (2007) Babel babble: Physicians use of unclarified medical jargon with patients. American Journal of Health Behavior 31(Suppl 1) S85–S95.CrossRefGoogle ScholarPubMed
Colon, M (2005) Hospice and Latinos: A review of the literature. Journal of Social Work in End-of-Life and Palliative Care 1, 27–43.CrossRefGoogle ScholarPubMed
Doak, CC, Doak, LG and Root, JH (1996) Teaching Patients With Low Literacy Skills. Philadelphia, PA: JB Lippincott.CrossRefGoogle Scholar
Hanchate, A, Kronman, AC, Young-Xu, Y, et al. (2009) Racial and ethnic differences in end of life costs: Why do minorities cost more than whites? Archives of Internal Medicine 169, 493–501.CrossRefGoogle ScholarPubMed
Kelley, AS, Wenger, NS and Sarkisian, CA (2010) Opiniones: End of life care preferences and planning among older latinos. Journal of American Geriatric Society 58(6), 1109–1116.CrossRefGoogle ScholarPubMed
Kutner, M, Greenbery, E and Baer, J (2005) A First Look at the Literacy of America's Adults in the 21st Century. Washington, DC: National Center for Education Statistics. Available at: https://nces.ed.gov/naal/pdf/2006470.pdf (accessed 10 January 2019).Google Scholar
Kwak, J and Haley, WE (2005) Current research findings on end-of-life decision making among racially or ethnically diverse groups. Gerontologist 45, 634–641.CrossRefGoogle ScholarPubMed
Loggers, ET, Maciejewski, PK, Paulk, E, et al. (2009) Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. Journal of Clinical Oncology 27, 5559–5564.CrossRefGoogle ScholarPubMed
Muni, S, Engelberg, RA, Treece, PD, et al. (2001) The influence of race/ethnicity and socioeconomic status on end-of-life care in the ICU. Chest 139(5), 1025–1033.CrossRefGoogle Scholar
Paasche-Orlow, MK, Parker, RM, Gazmararian, JA, et al. (2005) The prevalence of limited health literacy. International Journal of General Medicine 20(2), 175–184.CrossRefGoogle ScholarPubMed
Pan, CX, Abraham, O, Giron, F, et al. (2015) Just ask: Hospice familiarity in Asian and Hispanic adults. Journal of Pain and Symptom Management 49(5), 928–933.CrossRefGoogle ScholarPubMed
Perkins, HS, Geppert, CM, Gonzales, A, et al. (2002) Cross-cultural similarities and differences in attitudes about advance care planning. J Gen Intern Med. 17(1), 48–57.CrossRefGoogle ScholarPubMed
Pew Research Center (2019). Available at: https://www.pewresearch.org/fact-tank/2013/08/13/spanish-is-the-most-spoken-non-english-language-in-u-s-homes-even-among-non-hispanics/ (accessed 12 May 2019).Google Scholar
Rafaelli, M and Ontai, LL (2004) Gender socialization in Latino/a families: Results from 2 retrospective studies. Sex Roles 50(5-6), 287–299.CrossRefGoogle Scholar
Sabogal, F, Marin, G, Otero-Sabogal, R, et al. (1987) Hispanic familism and acculturation: What changes and what doesn't. Hispanic Journal of Behavioral Sciences 9, 397–412.CrossRefGoogle Scholar
Shen, MJ, Prigerson, HG, Paulk, E, et al. (2016) Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion. Cancer 122(11), 1749–1756.CrossRefGoogle ScholarPubMed
Smith, AK, Sudore, RL and Perez-Stable, EJ (2009) Palliative care for Latino patients and their families. JAMA 301(10), 1047–1057.CrossRefGoogle ScholarPubMed
Sudore, RL, Landefeld, CS, Williams, BA, et al. (2006) Use of a modified informed consent process among vulnerable patients: A descriptive study. Journal of Internal Medicine 21(8), 867–873.Google ScholarPubMed
Talamantes, MA, Lawler, WR and Espino, DV (1995) Hispanic American Elders: Caregiving norms surrounding the dying and the use of hospice services. Hospice Journal 10(2), 35–49.Google ScholarPubMed
Talamantes, MA, Gomez, C and Braun, KL (2000) Advance Directives and End-of-Life Care: The Hispanic Perspective. Cultural Issues in End-of-Life Decision-Making. Thousand Oaks, CA: Sage Publications, pp. 83–100.Google Scholar
Zaide, GB, Pekmezaris, R, Nouryan, CN, et al. (2013) Ethnicity, race, and advance directives in an inpatient palliative care consultation service. Palliative Support Care 11(1), 5–11.CrossRefGoogle Scholar