Hispanics Relationships an Eye to the Soul

1. Hispanics Relationships an Eye to the Soul The Vision of Opportunity Religious and Cultural Views on Donation and End of Life Issues April 17, 2012

2. Diversity • Social Aspects • Cultural Aspects • Bilingual • Bicultural

3. Immigrant Experience • “pillage/plunder” • Taken away without one’s permission • Always looking behind you • Losing one’s own blood • Fear of being caught

4. Being an immigrant not a natural choice • For life • For security • For education • Freedom of religion • Possibilities not offered in homeland

5. Cultural Competency • quality issue • cut costs of unnecessary testing • raise patient satisfaction scores • address the values of many of our institutions

6. Cultural Identity • Country of origin • Language • Education • Spiritual traditions • Family traditions • Diet and nutrition • Traditional medical practices • Attitudes about illness and death • Migration experiences

7. Cultural Competency • Is 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

8. Understanding someone’s cultural background helps create a comprehensive plan of care. • Becoming culturally competent is an ongoing process

9. 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

10. 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…

11. Basic guidelines • Learn about the values, family norms, traditions • Involve staff workers who are bilingual and bicultural • Establish rapport • Gain acceptance • Be nonjudgmental, respectful and credible • Practice active listening skills

12. Kaiser Permanente • What one hears and also what one sees • How those waiting relate with each other • Who is in charge and who does the family/group look to for help • How they address staff or other family members • EYE CONTACT

13. Hispanics misconceptions • Mutilation • Whole • Church • Need for Education • Mistrust of healthcare

14. Needs • Media • Education • Remember Hispanos are “warm blooded people” are relationship people • Help 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…

15. As Hispanics, we share a bond rooted in a proud culture of tradition and deeply passionate beliefs • We 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.

16. “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

17. Role of the Family in End of Life Decisions • Both the immediate and extended family • Decisions are made by consensus rather than individually • Family 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

19. Role of Religion and Spirituality • Patients and families turn to God for hope, believing that whatever happens will have meaning • Group Prayer • Mass offerings—Anointing of the Sick • Cleansings or limpias • Mandas • Preservation of life

21. Barriers to End-of-Life Care • Fear their beliefs would not be respected and addressed • Fear related to immigration status and discrimination • Reasons 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

22. Recommendations on End of Life Issues • Learn about the basic concepts of the culture • Acknowledge cultural differences and similarities • Provide education --US health system and disease processes • Keep an open communication channel • Explore patient’s beliefs and values • Collaborate and compromise to reach the most balanced consensus on decision making to provide the best possible care

23. 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?”

24. 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.”

25. 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?

26. 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)?”

27. 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