UNDERSTANDING HISPANIC CULTURE
Culturally proficient care is essential to reducing health care disparities among diverse ethnic groups. Cultural proficiency involves recognizing the attitudes, skills, behaviors, and policies that enable organizations to provide high-quality health care and preventive services effectively in cross-cultural situations.8 Beyond modifiable and nonmodifiable risk factors, effective communication and respect should be the foundation of the health care delivery system. Many Hispanic people maintain fatalistic beliefs that emphasize the present rather than the future. Preventive measures have a future orientation; therefore, the Hispanic culture gives little value to prevention or promotion.1 Early studies have noted the use of preventive services is lacking within the Hispanic culture.1 Spanish-speaking Hispanic people were less likely to receive preventive health services such as dental care, pneumonia and influenza immunizations, and breast and prostate cancer screenings compared with English-speaking Hispanic people, with no significant differences between the two groups regarding cervical cancer screenings.1,8 Understanding these beliefs and practices allows health care providers to tailor treatment plans, follow-up care, and multidisciplinary care.
Hispanic people regard the treatment they receive from clinicians as part of the healing process, not just the diagnosis and medical treatments.1,8 They also value support from traditional medicinal practitioners such as curanderas, espiritistas, or healers.8 This belief system integrates complementary treatments (eg, chamomile tea) with modern Western medicine (eg, antibiotics).
Some studies identified perceived disrespect as a barrier to care for Hispanic persons. In a national study of Anglo, African, Asian, and Hispanic Americans, investigators found that minority groups were significantly more likely to perceive disrespect and unfair medical treatment than were Anglo Americans.4 These people were less likely to participate in health screenings and recommended follow-up care as a result of such perceptions.3,4 This factor, combined with limited access and discrimination, can have a negative impact on the incidence rate of certain cancers such as cervical cancer in Hispanic women.
An approach for surveillance, treatment, and short- and long-term follow-up care for Hispanic oncology patients should incorporate an understanding of their cultural values and beliefs. The American Cancer Society (ACS) offers the following caveats to providing culturally proficient care to Hispanic families:
• Include the patient’s family members in the treatment planning process, beginning at diagnosis and throughout the cancer trajectory.
• Demonstrate respect for the patient’s culture. Mutual respect and trust are necessary elements to building the provider-patient relationship.
• Ask about the patient’s family, friends, and work. Allow Hispanic patients to share their life stories and pictures.
• Encourage participation in the health care process by asking the patient questions.
• Reach out to the community through community-based organizations in Hispanic neighborhoods, barrios, colonias, and other ethnic enclaves. This provides a significant entry point and opportunity to expand on any outreach effort you may be involved in.
• Respect the patient’s traditional healing approaches. Hispanic patients may combine mainstream medicine and traditional healing with a strong religious component.
ALLIANCES BUILD COMMUNITY-BASED OUTREACH
Clinicians, including advanced practitioners, should build alliances with resources that have the potential to reduce health care disparities, especially cancer risks in the Hispanic population. Although Hispanic people are unlikely to willingly participate in preventive care services, education and access must continue to be the focus of care. The American Cancer Society has contributed more than $100 million to the poor and medically underserved. Health care providers who partner with organizations such as ACS have access to resources for educating patients and structuring treatment at diagnosis that extends into survivorship.8 Prevention and control of risk factors are essential components for reducing the health care disparities that affect this population.
The Intercultural Cancer Council (ICC) is an organization that promotes policies, programs, partnerships, and research focused on eliminating the unequal burden of cancer among racial and ethnic minorities and medically underserved populations.8 ICC helps health care services meet the needs of diverse ethnic populations that extend beyond what these cultures traditionally accept. Another program specifically targeted toward the Hispanic community is Redes En Accion, a National Cancer Institute-funded initiative to promote cancer awareness and care in the Hispanic community. This initiative develops national and regional networks of partners engaged in cancer research, training, and awareness activities surrounding key cancer issues in this group.8 Utilizing these resources is imperative to improving cancer outcomes as well as other health care-related disparities within the Hispanic population.
The Hispanic community in the United States continues to grow at a rapid pace, and its health care needs will continue to expand. Disparities in cancer care is just one of the challenges facing the health care community, and these challenges will only worsen unless a change is made in how oncology services are delivered to this diverse group. Culturally competent care for the Hispanic community, as well as for other minority groups, continues to evolve. Health care services need to extend beyond Western cultural practices and clinicians’ personal ideals. Oncology care needs to incorporate the practices of other cultures in order to significantly impact health outcomes and preventive measures. Only then will we be able to make long-term changes for the better within this growing ethnic population. ONA
Jia Conway is a nurse practitioner at Cancer Care Associates of York in York, Pennsylvania.
1. Askim-Lovseth MK, Aldana A. Looking beyond “affordable” health care: cultural understanding and sensitivity—necessities in addressing the health care disparities of the U.S. Hispanic population. Health Mark Q. 2010;27(4):354-387.
2. Daniel M. Strategies for targeting health care disparities among Hispanics. Fam Community Health. 2010;33(4):329-342.
3. O’Brien MJ, Halbert CH, Bixby R, et al. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-1192.
4. Campesino M. Exploring perceptions of cancer care delivery among older Mexican American adults. Oncol Nurs Forum. 2009;36(4):413-420.
5. Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press; 2003. http://www.nap.edu/openbook.php?record_id=10260&page=33. Accessed July 24, 2012.
6. United States Census Bureau. The Hispanic population: 2000. Percent of population for one or more races. http://www.census.gov/prod/2001pubs/mso01-hp.pdf. Accessed July 17, 2012.
7. Young D. Health disparities affect cancer rates in Hispanics. Am J Health Syst Pharm. 2006;63(21):2034, 2036.
8. American Cancer Society. Cancer facts & figures for Hispanics/Latinos 2009-2011. http://www.cancer.org/acs/groups/content/@nho/documents/document/ffhispanicslatinos20092011.pdf. Accessed July 24, 2012.