Enrique Soto, MD, is a medical oncologist specializing in the care of older adults with cancer. He works at the Salvador Zubirán National Institute of Medical Sciences and Nutrition in Mexico City. Follow Dr. Soto on Twitter @EnriqueSoto8.
There are more than 50 million people of Hispanic descent living in the United States today, representing almost 20% of the nation’s total population. Although the majority of these people are young, 17 million will be over the age of 65 by 2050. Without doubt, this shift will bring with it a greater number of older Hispanic adults with cancer. Unfortunately, older Hispanic adults often face cultural and language barriers that can have a negative impact on the quality of medical care they receive. Research also shows that they tend to use medical services less, largely because of those barriers. To improve cancer care for today’s and tomorrow’s older Hispanic adults, it’s important for patients, their families, and their health care providers to have these 5 conversations:
1. Interpreter services
Many older Hispanic people came to the United States as adults. As a result, they might not fully understand the routines and procedures in the hospital and health care system. In addition, many don’t speak English well, meaning communication with doctors, nurses, and other health care team members isn’t always ideal. To resolve this problem, many hospitals employ interpreters during consultations or use telephone and teleconferencing translation systems. These services can help older Hispanic adults understand what’s being explained to them and reduce the burden placed on family members or caregivers, who sometimes feel they have to take on the role of interpreter. There are very few oncologists of Hispanic descent in the United States, but ASCO is working to increase the number of Latino and Spanish-speaking oncologists through the Diversity in Oncology initiative.
2. The role of family
The role of family in Hispanic culture is, in many cases, different from that found in other cultures. One of the central values for Latinos is familismo (familism), which emphasizes family loyalty, connections, and interdependence. Latino families are often very large, and older Hispanic adults may receive care from distant relatives, close friends, or other members of the community who are considered to be part of the family. It’s important, from the beginning of care, that the health care team is made aware of a family’s role. It’s also important for decisions to be made early on how information will be shared and with whom, especially when there are large numbers of children or family members involved.
3. Support systems
Another value that’s significant to Hispanic older adults is personalismo (personalism). In Latin American countries, relationships between people, including doctors, are often very personal and close. People are used to a familiar approach. This can sometimes be a challenge for older Hispanic people being cared for in U.S. hospitals, where relationships can appear more formal and impersonal. Support groups or help from social workers or patient navigators can offer patients the personal care that they sometimes need, so they can feel comfortable in the health care environment.
4. Religion and spirituality
Among older Latino or Hispanic adults, religion and spirituality often play a particularly vital role. Praying, going to Mass, and having faith in God are a main source of comfort and a way of coping with disease symptoms. Religious leaders within the community can help older Hispanic people who have cancer understand and accept their illness and help them make big decisions, especially those relating to advance directives and advanced cancer care planning.
This spiritual support can also help patients and families deal with fatalismo (fatalism), another very common Latino value. Fatalismo is the belief that the future is predetermined and not under our control. Although this can be a way of coping with cancer, a patient’s family and doctor need to discuss fatalistic beliefs and work together to clearly explain a cancer diagnosis and the treatment plan to the patient
5. Unique origins
Not all Hispanics or Latinos share the same origin. Hispanics in the United States may come from Mexico, Central America, the Caribbean, and South America. The customs, beliefs, and values of each country or region are different. Patients and their families should talk with their health care team to help them understand what their specific cultural needs will be. Common understanding can help the person with cancer receive the best care possible.