Hospice knowledge and intentions among Latinos using safety-net clinics.
BACKGROUND
Hospice use is low in Latinos but we know little about explanations for this pattern.


OBJECTIVE
To describe factors associated with knowledge of and intention to use hospice for cancer care.


METHODS
We conducted a Spanish-language, interviewer-administered cross-sectional survey of 331 Latino immigrants from Central and South America in safety-net clinics. Hospice intentions were measured using a hypothetical scenario. We used logistic regression and multiple imputations to test associations between cultural values, social acculturation, and other variables and knowledge and intentions.


RESULTS
Only 29% knew about hospice and 35% would choose hospice care (once it was defined). Collectivist (group-focused) views (odds ratio [OR] 1.06 per 1-point increase, 95% confidence interval [CI] 1.01-1.12, p=.05), endorsing family-centric values (OR 1.03 per 1-point increase, 95% CI 1.01-1.04, p=.004), and higher education were associated with greater hospice knowledge after considering covariates. Greater social ties were also independently associated with greater knowledge, but knowledge was not related to hospice intentions. Individuals who believed in maintaining secrecy about prognosis were 19% less likely to choose hospice than those who did not endorse secrecy (OR 0.81, 95% CI 0.67-0.99, p = .038). The most socially acculturated individuals were significantly more likely to choose hospice than those with less acculturation (OR 1.19 for each 1-unit increase, 95% CI 10.6-1.34, p = .004).


CONCLUSIONS
Hospice knowledge may be necessary but is not sufficient to increase hospice use among immigrant Latinos. Latino social networks and organizations may provide a natural leverage point for interventions. Interventions to increase hospice use may need to consider culturally related values.
Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA.
Claire
C
Selsky
Barbara
B
Kreling
Gheorghe
G
Luta
Solomon B
SB
Makgoeng
Jessika
J
Gomez-Duarte
Andrea Gabriela A
AG
Barbo
Jeanne S
JS
Mandelblatt
D000069:Acculturation; D000328:Adult; D000554:Ambulatory Care Facilities; D001293:Attitude to Death / Q000208:ethnology*; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005190:Family / Q000208:ethnology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017051:Hospice Care / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D033182:Intention; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D012945:Social Values / Q000208:ethnology