Understanding Gaps In End Of Life Care With Latinos: Experiences Of Providers Working In A Public Healthcare System
Gaps in end-of-life (EOL) care communication can cause problems with symptom management, influence over- or under-use of medical treatment, and trigger psychological distress. In addition, disparities among minority populations complicate this care because underserved populations face subsequent barriers that further hinder effective communication that impacts care. Issues that influence EOL care discussions stem from healthcare system factors within an organization, from the people working within the system, as well as within the people needing care, for example, from patients and their family/friend support systems. However, we know very little about the gaps in EOL care communication in the public healthcare system that, in turn, influence unnecessary suffering and prompt requests to hasten death.
The objective of this study was to evaluate the barriers to EOL care discussions as experienced by healthcare providers working in a public healthcare system in Los Angeles where the majority of their patients are low income and immigrant Latinos seeking medical treatment.
Forty-six semi-structured interviews were conducted with healthcare providers from different disciplines in medicine, nursing, social work, and chaplaincy working in a California Public Healthcare Setting. Data were analyzed using a constant comparison method rooted in grounded theory and a template matrix approach to compare provider perspectives across disciplines.
Most providers reported gaps in the public healthcare system that negatively influence EOL care discussions. Lack of an ambulatory infrastructure, limited resources, and lack of continuity of care minimized providers ability to effectively engage in EOL care communication. Patient and family member issues also contribute to the gaps in care. Themes revealed that EOL discussions occur infrequently even when they should occur, for example, shortly after a diagnosis of a life-limiting cancer condition like stage IV lung, pancreatic, or ovarian cancer. Instead, providers talked about how EOL care communication is often delayed until times of acute crisis, like when patients enter the hospital during an emergency, at which time patients’ wishes could not be thoroughly explored, and physicians could not focus on more existential, less immediately pressing issues.
Integration of findings demonstrated how barriers to health care in a public healthcare system hinder EOL care discussions in particular for vulnerable Latino patients. Underserved patients are in need of advocates to help them make informed medical decisions that reflect their best interest. Clinical social workers are in key positions to identify patient-centered care needs and influence medical teams to improve communication at the end of life. Implications and recommendations for improving practice with vulnerable populations will be discussed.