Hospice and Hispanics: Doctor-Patient Communication (Research, Video 2:52)

Cultural values play an important role in how racial-ethnic populations make decisions regarding terminal illness, caregiving, end-of-life experiences, and hospice participation. Communication is a critical factor in delivering information that can be understood in the context of these values. Doctors and their background training must reflect general cultural knowledge of racial-ethnic groups in order to communicate well with them, always keeping in mind that there are differences within populations.

With a focus on Hispanics, researchers at the University of South Florida School of Social Work studied factors that doctors use to communicate with patients. Communication involved revealing a terminally ill diagnosis and a hospice referral. Interviews conducted in Spanish and/or English with ten doctors in Central Florida reported these results relating to communication and related themes:

1)   Role of family members and end-of-life decisions

2)   Language barriers and limited knowledge of culture and beliefs relating to end-of-life decisions

3)   Gaps in training and education of doctors

Hispanics and other racial-ethnic populations that continue to be under-represented in hospice care must be included in the entitlement to death with dignity that the hospice philosophy supports. In order to improve representation, barriers such as language communication, knowledge of family roles, and cultural beliefs related to end-of-life decisions must be addressed. Better education and training of doctors and other healthcare workers can greatly improve their communication skills with various cultures.

This video from the Hospice Foundation of America Cares video series shares important information about Hispanic concerns that can help healthcare workers meet patients’ needs. Dorotea Gonzalez, nurse at Capital Hospice in Virginia, shares her perspectives on some of the philosophies at the foundation of Hispanic culture.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Elderly Healthcare Almost Two Years After Hurricane Katrina (Audio)

This is an update on healthcare of the elderly and others in New Orleans, my hometown, almost two years after Hurricane Katrina. What New Orleans needs most in the area of healthcare is a workforce. There is a severe shortage in medical doctors. In one Mid-City neighborhood, five doctors remain of the 120 practicing there before the hurricane.

While the general population is still far below previous numbers, it is much higher than the number of healthcare workers available. The few remaining hospitals are overcrowded. Large numbers of medical records were destroyed in the floods. Before the hurricane, 2,269 beds existed for acute care patients in Orleans Parish. Only 635 remain today. Many chronic mental patients who need hospital care have few services available. Besides depression, patients are suffering with post-traumatic stress disorder and substance abuse. The suicide rate has tripled.

New walk-in patients often show up with no medical records, no memory of prescriptions they had been taking, and no insurance. A significant number are elderly and on Medicaid. Chronic coughing, related to particles inhaled during cleanup and home renovation, is common. Treating patients is a stressful challenge to doctors, many whose own homes and private practices were destroyed.

As an incentive to increase the number of healthcare professionals, Louisiana is slated to receive a federal grant of $15 million dollars to provide up to $110,000 in payments to primary care doctors and other healthcare workers who move to New Orleans or surrounding areas. The government has a record of being extremely slow in disbursing financial aid in New Orleans.

Dr. Robert Travis Kenny, one of the five remaining Mid-City doctors, states, "I question why people with medical problems would return. Until you have enough hospital beds and the system gets up and running, it's a dangerous place to live for unhealthy people." Unfortunately, many unhealthy, elderly people have no other choice.

Most of the above information about healthcare in New Orleans came from an April 30, 2007 “Los Angeles Times” news article titled “A Post-Katrina Doctor Drought” by Ann M. Simmons.

You can listen to a more detailed account about the treatment of mental health patients in New Orleans at this June 11, 2007 interview titled “New Orleans Mental Health Crisis” at NPR.com

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Service Learning: Hospice Volunteer Medical Students

Service learning is a teaching and learning approach that connects classroom learning with meeting community needs. It is not the same as community service, another excellent practice. Service learning evolves from the classroom curriculum. For example, after students learn how to write a letter, they write a real letter to nursing home residents and possibly receive a letter response.

A former school principal, I have been a national service-learning consultant for many years and have been instrumental in implementing service-learning in school districts across the country. My book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes includes a chapter on intergenerational partnerships between schools and nursing homes. I know the positive impact it has on students, both academically and affectively. A win-win activity, it also positively impacts service partners.

The research article I’m about to address made me smile after I read it, not because it is funny, but because I knew what the outcome would be. Published by the “American Journal of Hospice and Palliative Care,” the article explains research using first-year, service-learning medical students to serve as hospice volunteers.

Hmmm, understaffed nursing homes with future doctors working as hospice volunteers --sounds like a perfect marriage. My thoughts were confirmed when I read, “There is evidence of the educational benefits of exposing medical students to hospice patients and practices.” The article states further, “It appears to be an efficient way to satisfy the need for volunteers, while contributing to the education of the involved students.”

Service learning is a great practice that is long overdue in this research context. I definitely hope that service as hospice volunteers in nursing homes will become a regular part of training for medical students.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog

Final Exam Book Review By Detroit Hospice Volunteer

Dr. Pauline Chen, author of Final Exam: A Surgeon's Reflections on Mortality, is a doctor who "gets" it. She understands that doctors can only do their best, that they won’t save every patient and that, in the natural order of life, they have not failed when their patients die. She realizes that doctors are just like other people and that in our common humanity, we often share similar needs. Finally, she knows that death can be a difficult journey, but consoling words can be powerful rest stops along the way.

In Final Exam, Dr. Chen takes the reader through her evolution with perceptions of death and mortality. She discusses personal feelings regarding her first dissection of a human cadaver. Later, she assumes responsibility for the accidental death of a patient in her care. Ultimately, she concludes that the role of doctors with patients and their loved ones should include more of the emotional comfort that traditionally has been missing too often. She adds that medical schools should educate doctors more in these caregiving strategies.

This book has important implications for hospice care. If doctors embrace Dr. Chen’s way of thinking, they will replace their feelings of failure when patients can no longer be cured with feelings of commitment to non-curative hospice care. They will recommend these options to patients more readily and increase the number of patients receiving quality health care at the end of their lives. In other words, they will “get” it and be comfortable with that knowledge.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog