Cultural and Structural Variables Affecting Hospice Utilization Among Mexican Americans

Abstract

The under-utilization of health care services by Mexican Americans and other minority groups is well documented. However, few studies have explored the reasons for minority under-utilization of hospice services. The purpose of this study was to examine the structural and cultural barriers that impede minority access to hospice services, and to present some ways in which hospices can overcome these barriers to better serve the Latino community. An extensive literature review revealed significant structural barriers, which included lack of knowledge of hospice services, inability to communicate with health care workers, lack of health insurance, and access issues related to the Medicare Hospice Benefit. Cultural barriers, which varied with level of acculturation, included the belief that terminally-ill family members should be cared for by other family members, the attitude that hospice care was impersonal or intrusive, the passive acceptance of terminal illness and a reluctance to report pain and discuss prognosis. In spite of the significant structural and cultural barriers, Mexican American terminally ill patients and their caregivers expressed a desire for formal services. Moreover, nurses and other health care providers expressed a desire to provide better care and to learn. about people from other cultures. Steps for improving existing hospice programs should include a hospice outreach program, a cultural education program for hospice staff, and recruitment of minority staff and volunteers. Cultural education programs for staff should focus not just on specific cultural beliefs, but on developing cultural sensitivity and flexibility within the context of holistic health care.