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.