Colo. – The cultural values of Latinos have a major impact on
their palliative care preferences and healthcare providers should be sensitive
to their perspectives, according to a research letter by physicians at the
University of Colorado School of Medicine.
Cervantes, MD, assistant professor of medicine, the lead author of the letter,
said she individually surveyed 61 Spanish and English-speaking Latino patients
who were receiving dialysis to treat kidney failure between September and
December 2014 and compared their responses with a previous study of Canadian
patients in similar circumstances.
observed a preference towards more aggressive care,” said Cervantes.
letter, published online last week in the American Journal of Kidney Diseases,
says that fewer patients in the Canadian cohort stated a preference for
resuscitation (38.9 percent) and many (60.7 percent) regret starting dialysis.
Among the Latinos in Cervantes’ study, the majority (70 percent) would prefer
resuscitation if their heart stopped and few (15 percent) regret the decision
to start dialysis.
the study of Canadian patients, most wanted to discuss end-of-life
decision-making when they became seriously ill. The Latinos in Cervantes’
survey preferred an earlier approach with conversations occurring soon after
they’ve started dialysis and while at home to allow for meaningful integration
of family into medical decision-making.
findings support the relevance of delivering palliative care in a way that is
sensitive to Latino culture and aligns with their values,” Cervantes said.
are one of the fastest-growing segments of the U.S. population and, as a group,
face a faster progression from chronic kidney disease to end-stage renal
disease when compared to non-Latino whites. All patients with end-stage
renal disease suffer a burden of debilitating symptoms and have a high
studies have found that Latinos are less likely to have advance directives, are
more likely to die in a hospital and, when faced with end-of-life decisions,
prefer a family-centered decision-making model. This survey by Cervantes and
colleagues is the first description of palliative care preferences and needs of
Latino patients with end-stage renal disease.
is an internal medicine hospitalist at Denver Health. Her co-authors on the
research letter are Stuart Linas, MD, professor of medicine, Angela Keniston,
MPH, research projects manager at Denver Health, and Stacy Fischer, MD,
associate professor of medicine. The study was funded by a Harold Amos Medical
Faculty Development Award from the Robert Wood Johnson Foundation.