Cancer is the leading cause of death for Hispanics in the United States. Although Hispanics make up 18% of the total US population, they account for 21% of cancer-related deaths.1 Hispanics are more likely to have later-stage disease at the time of diagnosis and are more likely to experience poorer health outcomes, even after diagnosis.

A number of different factors account for the disparity. Almost 23% of Hispanics in the United States live below the poverty level, compared with less than 11% of non-Hispanic whites. A greater percentage of Hispanics are uninsured or underinsured than are non-Hispanic whites. Language, education, acculturation, and immigration status all affect access to services for Hispanics.1,2

Providing culturally competent care to patients can greatly facilitate rapport, reduce patients’ stress and uncertainty, while increasing treatment compliance.3 Although the Hispanic community is large and diverse, there are some characteristics that can be applied generally. To navigate the common roadblocks to a successful relationship with your Hispanic patients, consider the following:

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Language If your patient is not a native English speaker, there is a higher probability of misunderstanding and confusion. In the midst of hearing about diagnosis or treatment protocol, every patient, regardless of language, can become overwhelmed, confused, or forgetful. When English is not their native language, patients may struggle to understand content and meaning. There are 20 Spanish speaking countries in Latin America and each has its own variation in the meaning of certain words and slang, so even when 2 Spanish speakers are communicating, they may need to clarity certain meanings. Whenever possible, check in with an interpreter, a family member, or the patient to make sure the information provided was clearly understood.

Maria, a client in CancerCare’s Spanish-speaking women support group, shared that she stopped taking her hormonal treatment because it made her feel not herself. Maria said the doctor told her it would be a good idea to take the medication. She understood that to mean it was optional. When she started experiencing side effects, Maria decided to stop the medication. After her peers urged her to talk to the nurse at her office, Maria was able to understand more about the treatment. Thanks to her nurse interpreting and advocating for her, Maria received a different prescription, which she tolerated better.

Family Culturally, life in the Hispanic community revolves around the family unit, with the community prioritizing the group over an individual person. A person’s wellbeing is the responsibility of the family, which usually includes extended family members and longtime friends. Several generations of one family living under the same roof is not uncommon. Understanding this different definition of family will allow for participation from any involved caregiver, regardless of blood relation, and help the patient trust and feel confidence in the medical team.

Authority Hispanics can defer to anyone in a position of authority, especially doctors or nurses. Patients might be hesitant to ask questions, raise concerns, or act as a strong advocate on their own behalf while discussing diagnosis and treatment plans. Taking the time to review the information to ensure the patient understands will help to ensure adherence to any treatment plan. Similarly, older Hispanic people can be considered authorities in the community and must be addressed in a formal way by using appropriate titles and their last name.

Religion The majority of the Hispanic population identifies as Christian and religion plays an important role in the community. Praying, attending mass, receiving support from a priest, and believing in miracles is a main source of comfort and support. Religion is a way of coping for the community, particularly among older generations. Understanding this and allowing religion to be part of the conversation will allow for a stronger relationship.

Navigating a cancer diagnosis and treatment is overwhelming for the patient and the family members on many levels. Meeting new doctors, specialists, testing appointments, follow-ups and receiving treatment can feel devastating and even unbearable. Doctors are not always available for long conversations or detailed explanations so nurses have always stepped in to fill that gap. Oncology nurses, in particular, are an essential support for patients navigating a high stress and terrifying reality. Nurses can provide an empathetic, competent, and comforting experience for patients in an oncology setting. Understanding patients in a cultural context will help improve the Hispanic patient’s experience.

For our support group member, Maria, clearer instructions from the doctor might have helped her understand the need to continue her treatment and the expected side effects. A culturally aware conversation with the oncology nurse, someone who Maria might have found more approachable, would have helped her make an educated decision about her treatment and likely ensured better treatment compliance.

References

1. Yanez B, McGinty HL, Buitrago D, Ramirez AG, Penedo FJ. Cancer outcomes in Hispanics/Latinos in the United States: an integrative review of conceptual model of determinants of health. J Lat Psychol. 2016;4(2):114-129.

2. Escarce JJ, Kapur K. Access to and quality of health care. In: National Research Council (US) Panel on Hispanics in the United States; Tienda M, Mitchell F, eds. Hispanics and the Future of America. Washington, DC: National Academies Press; 2006.

3. Flowers DL. Culturally competent nursing care: a challenge for the 21st century. Crit Care Nurse. 2004;24(4):48-52.