Hospice Knowledge and Intentions among Latinos Using Safety-Net Clinics

Abstract

Background: Hospice use is low in Latinos but we know little about explanations for this pattern. Objective: To describe factors associated with knowledge of and intention to use hospice for cancer care. Methods: We conducted a Spanish-language, interviewer-administered cross-sectional survey of 331 Latino immigrants from Central and South America in safety-net clinics. Hospice intentions were measured using a hypothetical scenario. We used logistic regression and multiple imputations to test associations between cultural values, social acculturation, and other variables and knowledge and intentions. Results: Only 29% knew about hospice and 35% would choose hospice care (once it was defined). Collectivist (group-focused) views (odds ratio [OR] 1.06 per 1-point increase, 95% confidence interval [CI] 1.01-1.12, p = .05), endorsing family-centric values (OR 1.03 per 1-point increase, 95% CI 1.01-1.04, p = .004), and higher education were associated with greater hospice knowledge after considering covariates. Greater social ties were also independently associated with greater knowledge, but knowledge was not related to hospice intentions. Individuals who believed in maintaining secrecy about prognosis were 19% less likely to choose hospice than those who did not endorse secrecy (OR 0.81, 95% CI 0.67-0.99, p = .038). The most socially acculturated individuals were significantly more likely to choose hospice than those with less acculturation (OR 1.19 for each 1-unit increase, 95% CI 10.6-1.34, p = .004). Conclusions: Hospice knowledge may be necessary but is not sufficient to increase hospice use among immigrant Latinos. Latino social networks and organizations may provide a natural leverage point for interventions. Interventions to increase hospice use may need to consider culturally related values.

Racial and ethnic differences in hospice enrollment among children with cancer

“…That Florida study also included children who died of all causes; nearly half died of "external" causes including accidents or trauma, few of whom were enrolled on hospice [10] thus possibly impacting their findings. Using administrative data, we were unable to directly measure acculturation retrospectively; however, limited English proficiency may be used as a surrogate for this [11,12]. This variable was also significantly associated with hospice enrollment, supporting our belief that in this case, Caucasians and Latinos represent two distinct racial/ethnic groups.…”

The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors

“…Since a standardised scale is needed for comprehensive evaluations, a previous study developed knowledge and attitude rating scales (Sung et al, ). However, as knowledge is not always representative of decision with regard to choosing a hospice, investigating decision towards hospice care is also important (Selsky et al, ). In the present study, we conducted validation research of the newly developed assessment tool on knowledge of hospice care, attitude towards hospice care and decision towards hospice care, and confirm the reliability, convergent and discriminant validity.…”

“…A cross‐sectional survey found that individuals with a high education level, strong social ties, family‐oriented personality and group‐focused values are likely to have better hospice knowledge. However, other quasi‐experimental studies have found that better hospice knowledge may not increase hospice decisions (Selsky et al, ; Sung, Wang, Fan, & Lin, ). Therefore, clarifying the associated factors and constructs is warranted to promote the utilisation of hospices (Hirai et al, ; McIlfatrick et al, ).…”

Just Ask: Hospice Familiarity in Asian and Hispanic Adults

“…8 Most of the older literature about hospice utilization focuses on comparisons between white populations vs. African-American populations, or white vs. ''others,'' without further details of ''others.'' 1,9e11 More recently, survey studies of Latino subjects in the U.S. have found low familiarity with hospice 12,13 but significant willingness to use hospice. 13 Similarly for Asian populations including Chinese and Koreans, recent studies report low familiarity with hospice and end-of-life services.…”

“…1,9e11 More recently, survey studies of Latino subjects in the U.S. have found low familiarity with hospice 12,13 but significant willingness to use hospice. 13 Similarly for Asian populations including Chinese and Koreans, recent studies report low familiarity with hospice and end-of-life services. 14e17 Queens County, NY, one of the most ethnically diverse counties in the U.S., 18 provides fertile ground for research in minority ethnic populations that are under-represented in national surveys.…”