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Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis.
Clin J Am Soc Nephrol. 2017 May 08; 12(5):788-798.CJ

Abstract

BACKGROUND AND OBJECTIVES

Compared with non-Latino whites with advanced illness, Latinos are less likely to have an advance directive or to die with hospice services. To improve palliative care disparities, international ESRD guidelines call for increased research on culturally responsive communication of advance care planning (ACP). The objective of our study was to explore the preferences of Latino patients receiving dialysis regarding symptom management and ACP.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Qualitative study design using semistructured face-to-face interviews of 20 Latinos on hemodialysis between February and July of 2015. Data were analyzed using thematic analysis.

RESULTS

Four themes were identified: Avoiding harms of medication (fear of addiction and damage to bodies, effective distractions, reliance on traditional remedies, fatalism: the sense that one's illness is deserved punishment); barriers and facilitators to ACP: faith, family, and home (family group decision-making, family reluctance to have ACP conversations, flexible decision-making conversations at home with family, ACP conversations incorporating trust and linguistic congruency, family-first and faith-driven decisions); enhancing wellbeing day-to-day (supportive relationships, improved understanding of illness leads to adherence, recognizing new self-value, maintaining a positive outlook); and distressing aspects of living with their illness (dietary restriction is culturally isolating and challenging for families, logistic challenges and socioeconomic disadvantage compounded by health literacy and language barriers, required rapid adjustments to chronic illness, demanding dialysis schedule).

CONCLUSIONS

Latinos described unique cultural preferences such as avoidance of medications for symptom alleviation and a preference to have family group decision-making and ACP conversations at home. Understanding and integrating cultural values and preferences into palliative care offers the potential to improve disparities and achieve quality patient-centered care for Latinos with advanced illness.

Authors+Show Affiliations

Divisions of Hospital Medicine and Lilia.Cervantes@dhha.org. Department of Medicine and.College of Nursing, University of Colorado, Denver, Colorado.Department of Medicine and. Nephrology, Department of Medicine, Denver Health, Denver Colorado; and.Division of General Internal Medicine, School of Medicine, and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28404600

Citation

Cervantes, Lilia, et al. "Qualitative Interviews Exploring Palliative Care Perspectives of Latinos On Dialysis." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 5, 2017, pp. 788-798.
Cervantes L, Jones J, Linas S, et al. Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis. Clin J Am Soc Nephrol. 2017;12(5):788-798.
Cervantes, L., Jones, J., Linas, S., & Fischer, S. (2017). Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis. Clinical Journal of the American Society of Nephrology : CJASN, 12(5), 788-798. https://doi.org/10.2215/CJN.10260916
Cervantes L, et al. Qualitative Interviews Exploring Palliative Care Perspectives of Latinos On Dialysis. Clin J Am Soc Nephrol. 2017 May 8;12(5):788-798. PubMed PMID: 28404600.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis. AU - Cervantes,Lilia, AU - Jones,Jacqueline, AU - Linas,Stuart, AU - Fischer,Stacy, Y1 - 2017/04/12/ PY - 2016/09/29/received PY - 2017/02/06/accepted PY - 2017/4/14/pubmed PY - 2018/3/6/medline PY - 2017/4/14/entrez KW - Advance Care Planning KW - Advance Directives KW - Chronic Disease KW - Communication Barriers KW - Fear KW - Health Literacy KW - Hemodialysis KW - Hispanic Americans KW - Hospice Care KW - Hospices KW - Humans KW - Kidney Failure, Chronic KW - Linguistics KW - Palliative Care KW - Patient Preference KW - Patient-Centered Care KW - Punishment KW - Qualitative Research KW - end-stage renal disease KW - ethnicity KW - quality of life KW - renal dialysis SP - 788 EP - 798 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 5 N2 - BACKGROUND AND OBJECTIVES: Compared with non-Latino whites with advanced illness, Latinos are less likely to have an advance directive or to die with hospice services. To improve palliative care disparities, international ESRD guidelines call for increased research on culturally responsive communication of advance care planning (ACP). The objective of our study was to explore the preferences of Latino patients receiving dialysis regarding symptom management and ACP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Qualitative study design using semistructured face-to-face interviews of 20 Latinos on hemodialysis between February and July of 2015. Data were analyzed using thematic analysis. RESULTS: Four themes were identified: Avoiding harms of medication (fear of addiction and damage to bodies, effective distractions, reliance on traditional remedies, fatalism: the sense that one's illness is deserved punishment); barriers and facilitators to ACP: faith, family, and home (family group decision-making, family reluctance to have ACP conversations, flexible decision-making conversations at home with family, ACP conversations incorporating trust and linguistic congruency, family-first and faith-driven decisions); enhancing wellbeing day-to-day (supportive relationships, improved understanding of illness leads to adherence, recognizing new self-value, maintaining a positive outlook); and distressing aspects of living with their illness (dietary restriction is culturally isolating and challenging for families, logistic challenges and socioeconomic disadvantage compounded by health literacy and language barriers, required rapid adjustments to chronic illness, demanding dialysis schedule). CONCLUSIONS: Latinos described unique cultural preferences such as avoidance of medications for symptom alleviation and a preference to have family group decision-making and ACP conversations at home. Understanding and integrating cultural values and preferences into palliative care offers the potential to improve disparities and achieve quality patient-centered care for Latinos with advanced illness. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/28404600/Qualitative_Interviews_Exploring_Palliative_Care_Perspectives_of_Latinos_on_Dialysis_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=28404600 DB - PRIME DP - Unbound Medicine ER -