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Compasión Familiar: Culturally Competent Palliative Care
for Latinos
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Module 1: Foundation
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Meeting the challenge
Where vision meets reality
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Learning Objectives: Module 1• Define palliative care• Understand expanded definition for your role• Define culturally competent care• Know difference between fact based and attitude/skill based
competence• Begin to understand and recognize common Latino cultural traits• See the value to your practice
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Define: Palliative Care• Specialized care • people with any serious, complex illness • to improve the quality of life for both the patient and the family
• Palliative Care IS for• any age • at any stage
• Palliative care is NOT• only for End of Life• only Hospice
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Palliative Care does…• work with other curative treatments• live better with the illness• provides support and relief
• "whole" person –physical, emotional, spiritual• patient and family members understand• active part in choosing options and goals• navigate
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Expanding Palliative Care• Expanded Definition• A verb, not a noun• Actions • Attitudes• YOU can offer Palliative Care
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Working Together
Cultural competence
Palliative Care
Patient Centere
d
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DEFINE: Patient Centered Care
• The IOM (Institute of Medicine) definition:• "Providing care that is respectful of and responsive to individual
patient preferences, needs, and values, • and ensuring that patient values guide all clinical decisions.“
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Truly Patient Centered?• Over 300 studies show that health information is not understood
(IOM report, 2004)• Tailor to the patient• Recognize cultural differences
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DEFINE: Culturally Competent Care
Effective Work in Cross Cultural
Situations
policies
attitudes
behaviors
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Every Encounter is Cross Cultural
Medical providers
Each patient
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Working Together
Cultural competence
Palliative Care
Patient Centere
d
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Moving Toward Cultural Competence
• Hispanic?• Latino?
Ask!
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AcculturationLevel of
Acculturation
Education, Socio-economic
Occupation, Living Place
Age, Gender, Family Position
Country of Origin
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Groups vs. Individuals• Diversity and commonality
• FACT BASED o Stereotypes
• Assumptions• Challenge: use knowledge about culture without losing the
individual
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Two Sides of Cultural Competence
Facts
Skills
and Attitudes
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Familismo • Gathering area• Identity and strength• Decision-making• Extended and deceased• Roots to home land
• Involve• Allow extra time• Patient = Family
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Without Family Support
• Don’t assume there is family support• Patient Navigators• Fill in the gaps
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As their Provider• Be aware of:
o key cultural issueso Information missing
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Familismo
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Familismo: Hierarchy
• Age • Gender
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Familismo
• Ask• Welcome• Respect lines of
communication• Ask who gets, who
gives
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Respeto and Dignidad• In the family and outside• Defer to authority due to: age, gender, social position, title, economic status, etc.
• Healthcare providers, and doctors especially
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How Respeto Might Show• Nod to show listening
o may not mean agreeing or understanding
• Disrespectful to ask questions or concerns• Assume they have no choice
o may not actually agree
• Politeness may hide stress or pain
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Personalismo• Relationship based• When patient is older than the provider…..• When provider is not known to patient or family….
• “Formal friendliness”• Senor, Senora, Dona NOT first name
alone• Good morning, good afternoon, how
do you do • Handshake
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Involve in Decision-making
• Clarify when there is choice• Check for understanding
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Espiritual and Fatalismo• Uncertainty is part of life• We are not in control
• Faith as strength, not excuse to give up• Faith may or may not be
religion
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Power Differential• Response to Pre-test• If you are or will be a healthcare provider • If you are of the majority• If you speak English
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Attitude
• Remember• Aware of imbalance even if
unspoken• Work against
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Why?• What are the benefits?
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Vision• Expanded definition of Palliative Care• Increased use of Palliative Care by Latinos
• For this to happen:• Increase health literacy—understanding of
Palliative Care—within Latino community• Develop a medical/social workforce ready to work
successfully with Latinos
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What is Health Literacy?• Health literacy: “the degree to which individuals have the capacity
to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
• 62% of Spanish speaking Americans have limited health literacy.
• Culturally competent care raises health literacy.
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Return on Investment: for Patients
• Deeper understanding• Skill to communicate across
cultures• Desire to communicate
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Vision• Expanded definition of Palliative Care• Expanded use of Palliative Care by Latinos
• For this to happen:• Increase health literacy—understanding of
Palliative Care—within Latino community• Develop a medical/social workforce ready to
work successfully with Latinos
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ROI: Return on Investment for YOU
• There is an established body of literature on the correlation between a practitioner’s capacity to provide culturally and linguistically competent care and improved health outcomes.
• Betancourt, Green, & Carrillo, 2002; Brach & Fraser, 2000; Flores et al., 2000; Kehoe, Melkus, & Newlin, 2003; Smedley, Stith, & Nelson, 2002.
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Ultimate Goal
Culturally
Competent Care
Improved Health Outcom
es
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Next Session• Culturally Inclusive ways to being a clinical relationship and elicit a
patient’s understanding of her condition• Why and how to use an interpreter• How to offer services of a patient navigator