How long have I got? The response influences quality of end-of-life care
The way in which bad news is communicated to patients at the end of their lives influences their quality of care. Researchers at the University of Houston Graduate College of Social Work are examining the perceptions and preferences of older Latinos with advanced cancer–one of the fastest growing segments in the aging population–about receiving news on their diagnosis or prognosis.
"In the U.S., we believe individuals have a right to know the absolute truth of their diagnosis and prognosis, but people from other cultures may have different communication styles and preferences," said Isabel Torres, associate professor in the college. "Some cultures prefer to protect their loved one from the distress of a terminal diagnosis. We want to find out what aspects of Latino culture influence their preferences. Additionally, we want to promote the culturally appropriate training of physicians and providers regarding communications at end-of-life."
Torres' two year study is supported by a grant from the National Institutes of Health/National Institute of Nursing Research.
She is surveying 100 older Latinos with stage three or four locally advanced, recurrent or metastatic cancer, and their caregivers. The study also interviews older Anglo patients with advanced cancer and their family caregivers. All are being asked about their preferences regarding the content, style and timing of diagnostic and prognostic information.
"Meeting the communication needs and preferences of advanced cancer patients and their families is central to the delivery of quality care," she said. "Knowing these preferences is a key ingredient for improving patient outcomes, as well as the use and quality of palliative care services."
Her research identifies communication preferences of Latino patients and families and illustrates and assesses the multiple dimensions of Latino culture in the area of health disparities in palliative care. Torres' investigation builds on her expansive body of research that examines ethnic health disparities in palliative care, specifically the factors that influence access to and quality of advanced cancer care.
Her previous research in Latin America suggests that there has been a significant shift towards enhanced disclosure in communication preferences and practices regarding cancer diagnosis and prognosis.
"Yet, other recent research suggests a substantial percentage of Latinos with advanced cancer in Houston would not want their doctor to tell them if he/she knew how long they had to live," she said. "Findings such as these made me realize this important topic required its own study."
Previous investigations have examined treatment and decision making preferences of older Latinos with advanced cancers, as well as how patients and caregivers view the delivery of artificial hydration to patients during end of life–all with an eye on how interventions and training of physicians, health care providers and caregivers can improve quality of care.
Torres collaborates with researchers from the University of Texas M.D. Anderson Cancer Center where she also is a visiting associate professor in the Department of Palliative, Rehabilitation and Integrative Medicine.