End-of-Life Care Communication

For Hispanic/Latino Elders and their Families

Hispanic/Latino elderly are more likely to prefer family-centered decision making than other ethnic groups. Variations within groups existed and were related to cultural values, demographic characteristics, level of acculturation, and knowledge of end-of-life treatment options (Kwak, 2005).

S.P.I.K.E.S. Communication Model

Different communication models have been suggested to approach the delivery of bad news and end of life decision making in family meetings. Models such as “S.P.I.K.E.S.” may be helpful (Baile and Buckman, 2006), particularly when dealing with large numbers of family members. The model incorporates the following framework:

With Latino families, discussing the “Patient” or “bringing the patient into the room,” in the form of asking family members about the patient preferences and/or specific questions such as—Who is the patient? What are the patient’s values? These questions may be helpful, as they redirects the discussion to what the patient would have wanted, rather than the families’ desires (Ragan, Wittenberg-Lyles, Goldsmith and Sanchez-Reilly, 2008).

Suggestions for respectful end of life communication with elderly from Hispanic/Latino backgrounds and their families include:

  • As a sign of respect, older persons should be addressed by their last name
  • Family meetings are recommended, including as many relatives as requested by the family and as appropriate to each patient
  • If the health provider is not bilingual, supply outside (non-family) translation services if available and needed
  • It is possible that there will be larger family meetings, thus it is important to include all family members in the discussions; however identify the power of attorney for health care and the primary family spokesperson
  • Consider consulting palliative care services, as they have more experience in managing large family meetings
  • Assess with the patient and thier families understand the discussions. It is possible that some persons will nod “yes” but not really comprehend and are embarrassed to ask for clarification. Try to avoid medical jargon and explain terminology as much as possible
  • Outright questioning of authority figures, such as a physician, is taboo in some cultures, so it is important for the provider to encourage the patient and family to ask questions
  • Propose a plan of care for the patient and leave your contact information with the family