Providing Culturally Sensitive Palliative Care

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.”