1. Compasión Familiar: Culturally Competent Palliative Care for Latinos

2. Module 1: Foundation

3. Meeting the challenge Where vision meets reality

4. Learning Objectives: Module 1 Define palliative care Understand expanded definition for your role Define culturally competent care Know difference between fact based and attitude/skill based competence Begin to understand and recognize common Latino cultural traits See the value to your practice

5. Define: Palliative Care Specialized care people with any serious, complex illness to improve the quality of life for both the patient and the family Palliative Care IS for any age at any stage Palliative care is NOT only for End of Life only Hospice

6. Palliative Care does… work with other curative treatments live better with the illness provides support and relief "whole" person –physical, emotional, spiritual patient and family members understand active part in choosing options and goals navigate

7. Expanding Palliative Care Expanded Definition A verb, not a noun Actions Attitudes YOU can offer Palliative Care

8. Working Together Cultural competence Palliative Care Patient Centered

9. DEFINE: Patient Centered Care The IOM (Institute of Medicine) definition: "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.“

10. Truly Patient Centered? Over 300 studies show that health information is not understood (IOM report, 2004) Tailor to the patient Recognize cultural differences

11. DEFINE: Culturally Competent Care Effective Work in Cross Cultural Situations policiesattitudesbehaviors

12. Every Encounter is Cross Cultural Medical providers Each patient

13. Working Together Cultural competence Palliative Care Patient Centered

14. Moving Toward Cultural Competence Hispanic? Latino? Ask!

15. Acculturation Acculturation Level of Acculturation Education, Socio-economic Occupation, Living Place Age, Gender, Family Position Country of Origin

16. Groups vs. Individuals Diversity and commonality FACT BASED o Stereotypes Assumptions Challenge: use knowledge about culture without losing the individual

17. Two Sides of Cultural Competence Facts Skills and Attitudes

18. Familismo Gathering area Identity and strength Decision-making Extended and deceased Roots to home land Involve Allow extra time Patient = Family Involve Allow extra time Patient = Family

19. Without Family Support Don’t assume there is family support Patient Navigators Fill in the gaps

20. As their Provider Be aware of: o key cultural issues o Information missing

21. Familismo

22. Familismo: Hierarchy Age Gender

23. Familismo Ask Welcome Respect lines of communication Ask who gets, who gives

24. Respeto and Dignidad In the family and outside Defer to authority due to: age, gender, social position, title, economic status, etc. Healthcare providers, and doctors especially

25. How Respeto Might Show Nod to show listening o may not mean agreeing or understanding Disrespectful to ask questions or concerns Assume they have no choice o may not actually agree Politeness may hide stress or pain

26. Personalismo Relationship based When patient is older than the provider….. When provider is not known to patient or family…. “Formal friendliness” Senor, Senora, Dona NOT first name alone Good morning, good afternoon, how do you do Handshake

27. Involve in Decision-making Clarify when there is choice Check for understanding

28. Espiritual and Fatalismo Uncertainty is part of life We are not in control Faith as strength, not excuse to give up Faith may or may not be religion

29. Power Differential Response to Pre-test If you are or will be a healthcare provider If you are of the majority If you speak English

30. Attitude Remember Aware of imbalance even if unspoken Work against

31. Why? What are the benefits?

32. Vision Expanded definition of Palliative Care Increased use of Palliative Care by Latinos For this to happen: Increase health literacy—understanding of Palliative Care—within Latino community Develop a medical/social workforce ready to work successfully with Latinos

33. What is Health Literacy? Health literacy: “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” 62% of Spanish speaking Americans have limited health literacy. Culturally competent care raises health literacy.

34. Return on Investment: for Patients Deeper understanding Skill to communicate across cultures Desire to communicate

35. Vision Expanded definition of Palliative Care Expanded use of Palliative Care by Latinos For this to happen: Increase health literacy—understanding of Palliative Care—within Latino community Develop a medical/social workforce ready to work successfully with Latinos

36. ROI: Return on Investment for YOU There is an established body of literature on the correlation between a practitioner’s capacity to provide culturally and linguistically competent care and improved health outcomes. Betancourt, Green, & Carrillo, 2002; Brach & Fraser, 2000; Flores et al., 2000; Kehoe, Melkus, & Newlin, 2003; Smedley, Stith, & Nelson, 2002.

37. Ultimate Goal Culturally Competent Care Improved Health Outcomes

38. Next Session Culturally Inclusive ways to being a clinical relationship and elicit a patient’s understanding of her condition Why and how to use an interpreter How to offer services of a patient navigator