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Providing Culturally Sensitive Palliative Care

Practicing culturally appropriate medicine is applicable beyond palliative care and across all medical specialties.

In JAMA’s Clinician’s Corner, the case of an undocumented immigrant from Central America who died of leukemia soon after the birth of her child is presented to illustrate the influence of culture among Latino families concerning end-of-life care. Interviews conducted with the palliative care attending physician, chaplain, medical student, and social worker demonstrate the disconnect that evolved between the patient, her partner, and the medical team.

Distance from family, fear of deportation, and limited health literacy were identified by the authors as major barriers to delivering quality palliative care. The authors discuss the influence of culture and religion (e.g., familismo, machismo, and fatalismo) on patient care, noting that up to 92% of Latinos consider themselves religious. Use of professional interpreters for important conversations is stressed. Suggestions for working with interpreters effectively include clarifying confidentiality, briefing the interpreter before entering a patient’s room, and using telephone interpreters when in-person interpreters are not available.

Recommended phrases to use with interpreters include:

• "Before we go in the room, I want to clarify my meeting communication style and goals."
  
• "I depend on you not only to interpret the words but also to be aware of the context for the conversation."
  
• "If the patient [or I] says something you don’t know how to interpret, please let me know."
  
• "Do you have any concerns about the family’s understanding?"
  

Recommended phrases to use with patients include:

• "I want to introduce you to the medical interpreter. We are using an interpreter because the topics we are discussing are important, and we need to communicate clearly with one another."
  
• "I want to reassure you that neither the interpreter nor I will report on your status to government immigration authorities."
  

Comment: The value of this article is in the concrete suggestions that are provided for improving health communication with Latino families. The explicit scripts provided for working with interpreters are especially useful for well-meaning physicians who do not have natural communication skills or experience in communicating through interpreters. Tips for practicing culturally sensitive medicine are applicable beyond palliative care and across all medical specialties.

— Sarah Bergman Lewis, MD

Dr. Bergman Lewis is a first-year resident at University of Washington School of Medicine, Seattle Children’s Hospital, Seattle.

Published in Journal Watch Pediatrics and Adolescent Medicine April 15, 2009

Citation(s):

Smith AK et al. Palliative care for Latino patients and their families: Whenever we prayed, she wept. JAMA 2009 Mar 11; 301:1047.

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Reader Remarks:

Review and add to remarks on this article

• "Latino"
  M Lannes, McGill University Health Center, 21 Apr 2009 6:12 PM EST
  I understand the purpose and the value of these studies. I think, however, that anybody that has to deal with... [more]
• cultural competency
  Dr. Sarah Bergman Lewis, Resident, Seattle Children's, 4 May 2009 3:04 PM EST
  Dr. Lannes-
  
  I appreciate your letter and entirely agree with the sentiment you've shared. The entire purpose of cultural competency... [more]

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