Exploring Serious Illness Communication between Latino Spanish-Speaking Older Adults and Community-Based Palliative Care Clinicians
Funded Grant
Overview
Affiliation
View All
Overview
description
Project Summary/Abstract Over 5 million Americans aged 65 and older identify as Hispanic or Latino (hereafter Latino), nearly two-thirds of whom speak Spanish at home. Compared to non-Latino White older adults, Latino older adults are also more likely to have a serious illness, a health condition that carries a high risk of mortality and negatively impacts a person’s daily function or quality of life. Despite high rates of serious illness, Latino older adults have less engagement in serious illness communication (SIC) compared to non-Latino counterparts. SIC is a process of structured, emotionally supportive conversations about prognosis, values, and priorities to inform care decisions. High-quality SIC is associated with improved quality of life, care aligned with patient preferences, and enhanced clinician satisfaction, while poor communication is linked to emotional distress and lower-quality care. Multiple tools to teach SIC exist, but early research examining their acceptability and impact was conducted primarily in White, English-speaking populations whose communication needs may not reflect those of more diverse populations. Critical care gaps remain for SIC with Latino older adults: (a) clinicians cite barriers to initiating SIC with diverse patients, (b) interpreters report that interpreted SIC conversations usually go well only half of the time, and (c) clinicians receive little guidance on how to navigate SIC when the patient and clinician have language discordance, which is more common in older adults. To fill these gaps, the applicant has conducted initial research on the SIC experiences of hospitalized Latino Spanish-speaking patients and inpatient palliative care clinicians. However, SIC differs between care settings and requires different skills in community-based (clinic and home-based) settings: conversations about urgent, real-time decisions in the hospital setting differ from conversations outside the hospital where clinicians support patients in care planning over time with more time for rapport-building and addressing coping. The objective of this proposal is to explore SIC needs and experiences of Latino Spanish-speaking older adults engaging in community-based palliative care from the perspective of patients, palliative care clinicians, and professional medical interpreters. This proposal investigates two specific aims: (1) to explore the SIC needs and experiences of Latino Spanish-speaking older adults in community-based palliative care settings (half who had a language-concordant visit and half who had a language-discordant visit), and (2) to explore monolingual and bilingual palliative care clinicians and professional medical interpreters’ perspectives on the unique needs, experiences, barriers, and facilitators with conducting SIC with Latino Spanish-speaking older adults in community-based palliative care settings. This work will inform future clinician- and interpreter-facing SIC skill development interventions and improve serious illness communication and care for Latino Spanish-speaking older adults. This work will lay the groundwork for expanding SIC skill development interventions to different clinicians (e.g., primary care and oncology) who support Latino Spanish-speaking older adults.
