Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA.
J Palliat Med. 2012 Sep;15(9):984-90. doi: 10.1089/jpm.2011.0517. Epub 2012 Jun 25.
Hospice use is low in Latinos but we know little about explanations for this pattern.
To describe factors associated with knowledge of and intention to use hospice for cancer care.
We conducted a Spanish-language, interviewer-administered cross-sectional survey of 331 Latino immigrants from Central and South America in safety-net clinics. Hospice intentions were measured using a hypothetical scenario. We used logistic regression and multiple imputations to test associations between cultural values, social acculturation, and other variables and knowledge and intentions.
Only 29% knew about hospice and 35% would choose hospice care (once it was defined). Collectivist (group-focused) views (odds ratio [OR] 1.06 per 1-point increase, 95% confidence interval [CI] 1.01-1.12, p=.05), endorsing family-centric values (OR 1.03 per 1-point increase, 95% CI 1.01-1.04, p=.004), and higher education were associated with greater hospice knowledge after considering covariates. Greater social ties were also independently associated with greater knowledge, but knowledge was not related to hospice intentions. Individuals who believed in maintaining secrecy about prognosis were 19% less likely to choose hospice than those who did not endorse secrecy (OR 0.81, 95% CI 0.67-0.99, p = .038). The most socially acculturated individuals were significantly more likely to choose hospice than those with less acculturation (OR 1.19 for each 1-unit increase, 95% CI 10.6-1.34, p = .004).
Hospice knowledge may be necessary but is not sufficient to increase hospice use among immigrant Latinos. Latino social networks and organizations may provide a natural leverage point for interventions. Interventions to increase hospice use may need to consider culturally related values.
临终关怀在拉丁裔人群中的使用率较低，但我们对造成这种模式的原因知之甚少。
描述与癌症护理中临终关怀知识和使用意向相关的因素。
我们对来自中美洲和南美洲的 331 名拉丁裔移民进行了西班牙语访谈式横断面调查，这些移民来自于医疗服务提供网络。采用假设情景来衡量临终关怀意向。我们使用逻辑回归和多重插补来检验文化价值观、社会融入和其他变量与知识和意向之间的关联。
只有 29%的人了解临终关怀，35%的人会选择临终关怀（一旦定义）。具有集体主义（以群体为中心）观点（每增加 1 分，比值比 [OR] 为 1.06，95%置信区间 [CI] 为 1.01-1.12，p =.05）、支持以家庭为中心的价值观（每增加 1 分，OR 为 1.03，95% CI 为 1.01-1.04，p =.004）和较高的教育程度与考虑了混杂因素后的临终关怀知识增加相关。更强的社会联系也与更多的知识相关，但知识与临终关怀意向无关。与不支持隐瞒预后的人相比，认为应该对预后保密的个体选择临终关怀的可能性低 19%（OR 0.81，95% CI 0.67-0.99，p =.038）。社会融入程度最高的个体选择临终关怀的可能性明显高于融入程度较低的个体（每增加 1 个单位，OR 为 1.19，95% CI 为 10.6-1.34，p =.004）。
临终关怀知识可能是必要的，但不足以增加移民拉丁裔人群对临终关怀的使用。拉丁裔社交网络和组织可能为干预提供了一个自然的着力点。增加临终关怀使用的干预措施可能需要考虑与文化相关的价值观。
