Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis
Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis
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DOI：
10.2215/cjn.10260916
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发表时间：
2017-05-01
影响因子：
9.8
通讯作者：
Fischer, Stacy
中科院分区：
文献类型：
--
作者：
Cervantes, Lilia;Jones, Jacqueline;Fischer, Stacy
背景和目的与晚期疾病的非拉丁裔白人相比，拉丁裔不太可能有预先指示或与临终关怀服务。为了改善姑息治疗的差异，国际ESRD指南呼吁加强对提前护理计划（ACP）的文化响应沟通的研究。我们的研究的目的是探讨拉丁美洲患者接受透析有关症状管理和ACP.Design的偏好，设置，参与者，和测量定性研究设计，使用半结构化的面对面访谈的20个拉丁美洲人之间的血液透析2015年2月和7月。采用主题分析法对数据进行分析。（害怕上瘾和对身体的损害，有效的分心，依赖传统疗法，宿命论：一个人的疾病是应该受到惩罚的感觉）; ACP的障碍和促进因素：信仰，家庭，和家（家庭群体决策，家庭不愿进行ACP对话，在家中与家人进行灵活的决策对话，ACP对话包含信任和语言一致性，家庭第一和信仰驱动的决定）;提高日常福祉（支持性关系，对疾病的更好理解导致坚持，认识到新的自我价值，保持积极的前景）;和痛苦的一面（饮食限制在文化上是孤立的，对家庭来说是一个挑战，后勤挑战和社会经济劣势加上健康知识和语言障碍，需要迅速适应慢性疾病，要求透析时间表）。结论拉丁美洲人描述了独特的文化偏好，如避免药物缓解症状和偏好有家庭小组决策和ACP对话在家里。理解和整合文化价值观和偏好到姑息治疗提供了改善差距和实现高质量的以病人为中心的护理与晚期疾病的拉丁美洲人的潜力。
Background and objectives Compared with non-Latino whites with advanced illness, Latinos are less likely to have an advance directive or to die with hospice services. To improve palliative care disparities, international ESRD guidelines call for increased research on culturally responsive communication of advance care planning (ACP). The objective of our study was to explore the preferences of Latino patients receiving dialysis regarding symptom management and ACP.Design, setting, participants, & measurements Qualitative study design using semistructured face-to-face interviews of 20 Latinos on hemodialysis between February and July of 2015. Data were analyzed using thematic analysis.Results Four themes were identified: Avoiding harms of medication (fear of addiction and damage to bodies, effective distractions, reliance on traditional remedies, fatalism: the sense that one's illness is deserved punishment); barriers and facilitators to ACP: faith, family, and home (family group decision-making, family reluctance to have ACP conversations, flexible decision-making conversations at home with family, ACP conversations incorporating trust and linguistic congruency, family-first and faith-driven decisions); enhancing wellbeing day-to-day (supportive relationships, improved understanding of illness leads to adherence, recognizing new self-value, maintaining a positive outlook); and distressing aspects of living with their illness (dietary restriction is culturally isolating and challenging for families, logistic challenges and socioeconomic disadvantage compounded by health literacy and language barriers, required rapid adjustments to chronic illness, demanding dialysis schedule).Conclusions Latinos described unique cultural preferences such as avoidance of medications for symptom alleviation and a preference to have family group decision-making and ACP conversations at home. Understanding and integrating cultural values and preferences into palliative care offers the potential to improve disparities and achieve quality patient-centered care for Latinos with advanced illness.