The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 14: Culture and CareInterventionsTaking into account Hispanic core values, aforementioned barriers, and end-of-life preferences,what26canpicasthe health care provider do to improve palliative care for the Hispanic client?First, it is important that health care professionals increase their knowledge about Hispanicculture, by becoming familiar with the history of the subgroups they are dealing with, along withthe family, social, and religious values associated with Hispanic culture. This as well as learningto speak Spanish will help providers display respect and build trust. 10Second, the provider should include family members in discussions with the patient regardingpalliative care. Needless to say, there may be situations in which the patient may not desire tohave the family included, and this, of course, should be respected. 15Finally, it is important to have open and clear communication with the patient and family, sincedeference and respect to the provider due to jerarquismo may lead the Hispanic patient towithhold information or hesitate to communicate honestly. The provider must ascertain whetherthe patient understands the treatment being offered, and whether he or she fully agrees withthe treatment plan. 25 This is particularly important when it comes to end of life decisionmakingand advance directives, as research indicates that there are several factors that discouragediscussions on these topics. 22, 23, 19 Jerarquismo may lead the patient and family to have unrealisticexpectations as to what conventional treatment can offer. The family may be expecting amiracle cure for the terminally ill patient, and thus may refuse to consider palliative care treatmentoptions. Further, perceived conflicts between the patient’s religion and withdrawing orwithholding of treatment may be addressed and clarified by including a clergy member indecisionmaking.The role of community education cannot be overstated, particularly when one considers thedegree of marginalization many Hispanics face due to language, racism and other socio-economicbarriers, including legal status. Education should be provided directly by the health careteam because of the value placed on personalismo, and the target audience should include theentire community: patients, families, and community leaders, including clergy. The provider canshare with the Hispanic community not only general information about HIV/AIDS, but also informationabout end-of-life issues, palliative care and the role of hospice. Education can also beenhanced by identifying members of the community living with HIV/AIDS to serve as role modelsto share their own experiences with the illness. The provider should not rely on brochuresalone for education, since the language used in many brochures may be above the reading levelof many Hispanics, may only exist in English, or may be poorly translated. 26XIVU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 305