The Vision of OpportunityReligious and Cultural Views on Donation and End of Life Issues

April 17, 2012

Hispanics Relationships an Eye to the

Soul

DiversitySocial AspectsCultural AspectsBilingualBicultural

Immigrant Experience“pillage/plunder”Taken away without one’s permissionAlways looking behind youLosing one’s own bloodFear of being caught

Being an immigrant not a natural choice

For lifeFor securityFor educationFreedom of religionPossibilities not offered in homeland

Cultural Competencyquality issuecut costs of unnecessary testingraise patient satisfaction scoresaddress the values of many of our

institutions

Cultural IdentityCountry of originLanguageEducationSpiritual traditionsFamily traditionsDiet and nutritionTraditional medical practicesAttitudes about illness and deathMigration experiences

Cultural CompetencyIs the ability to interact successfully with

people from various ethnic and/or cultural groups.

As health care providers we must gather information from the patient and/or family that can be useful in the plan of care.

Relevant data pertinent to the patient’s situation and/ or bio-psycho-social-spiritual/religious health

Understanding someone’s cultural background helps create a comprehensive plan of care.

Becoming culturally competent is an ongoing process

CLAS Standard 13…“Health care organizations should ensure

that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.”

Some may not feel comfortable putting a complaint in writing

People whose voices not heard

CLAS Standard 14…“Health care organizations are encouraged

to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.”

Share information through public events, health fairs, faith-based organizational events, and cultural media outlets…

Basic guidelinesLearn about the values, family norms,

traditionsInvolve staff workers who are bilingual and

biculturalEstablish rapportGain acceptanceBe nonjudgmental,

respectful and crediblePractice active listening skills

Kaiser PermanenteWhat one hears and also what one seesHow those waiting relate with each otherWho is in charge and who does the

family/group look to for helpHow they address staff or other family

members

EYE CONTACT

Hispanics misconceptionsMutilationWholeChurchNeed for Education

Mistrust of healthcare

NeedsMediaEducationRemember Hispanos are “warm blooded

people” are relationship peopleHelp them understand through relationship

building, donation takes place after death, signing up as donors not at risk of organs taken before death, need of all body parts for afterlife, personal expressions…

As Hispanics, we share a bond rooted in a proud culture of tradition and deeply passionate beliefsWe share the unique ability to help our

families, friends and community members who are waiting for an organ, tissue or eye donation

Talk to your family and your friends. You will probably discover that the need for donation is closer than you think.

“The Mexican is familiar with death ,Jokes about it, caresses it, sleeps with it, celebrates it:It is one of his favorite toys and his most steadfast love… he looks at it face to face with impatience, disdain of irony.”--Tellez-Giron 2007

Role of the Family in End of Life DecisionsBoth the immediate and extended familyDecisions are made by consensus rather

than individuallyFamily and friends are seen as a great

comfort (one letter per family does not work with Hispanics)

Enduring pain is part of the role of family members, meant to protect other family members from suffering and worrying

Role of Religion and SpiritualityPatients and families turn to God for hope,

believing that whatever happens will have meaning

Group PrayerMass offerings—Anointing of the SickCleansings or limpiasMandas

Preservation of life

Barriers to End-of-Life CareFear their beliefs would not be respected and

addressedFear related to immigration status and

discriminationReasons for the lack of Hospice care include

language barriers, cultural beliefs, distrust in institutions and poor information about services

Some believe that the health care system controls treatment and that communicating one’s wishes to caregivers is pointless

Use Promotoras

Recommendations on End of Life IssuesLearn about the basic concepts of the cultureAcknowledge cultural differences and

similaritiesProvide education --US health system and

disease processesKeep an open communication channelExplore patient’s beliefs and valuesCollaborate and compromise to reach the

most balanced consensus on decision making to provide the best possible care

Cross Cultural Interview Questions Regarding End-of-Life Issues“Some people want to know everything

about their medical condition, and others do not. What is your preference?”

“Do you prefer to make medical decisions about future tests or treatments for yourself, or would you prefer that someone else make them for you?”

To patients who request that the physician discuss their condition with family members:“Would you be more comfortable if I spoke with your (brother, son, daughter) alone, or would you like to be present?”If the patient chooses not to be present:“If you change your mind at many point and would like more information, please let me know. I will answer any questions you have.”

When discussing medical issues with family members, particularly through a translator, it is often helpful to confirm their understanding:

“I want to be sure that I am explaining your mother’s treatment options accurately. Could you explain to me what you understand about your mother’s condition and the treatment that we are recommending?”

“Is there anything that would be helpful for me to know about how your family/community/religious faith views serious illness and treatment?

Sometimes people are uncomfortable discussing these issues with a doctor who is of a different race or cultural background. Are you comfortable with me treating you? Will you please let me know if there is anything about your background that would be helpful for me to know in working with you or your (mother, father, sister, brother)?”

Bibliography“Cultural Competencies” Professional Spiritual

and Pastoral Care, Edited by Rabbi Stephen B. Roberts, 2011 Skylight Paths

Latino Catholicism, Timothy Matovina, 2012 Princeton University Press

Donate Life Texas, Texas Registry 2009“Attitudes, Beliefs and Behaviors Surrounding

Organ Donation among Hispanic Women”, NIH Public Access, 2009

“End-of-Life Issues for Hispanics”, David Acosta, M>D> and Maribel Serrano, University of Washington, 2008