Hispanic Hospice Utilization: Integrative Review and Meta-analysis.

Hospice is patient-centered end-of-life care. Hispanics are underrepresented among hospice patients (7.1%) relative to the U.S. population (17%). We conducted a systematic review of the literature and meta-analysis to understand this underrepresentation further. In palliative care, Hispanic hospice enrollment is comparable to that of non-Hispanic Whites (NHWs) (RR 1.02, 95% CI: 0.93-1.12; z=0.49; p = .627). However, in cases of heart failure (OR 0.49, 95% CI 0.37-0.66) and stroke (OR 0.77, 95% CI 0.63-0.94), Hispanics are much less likely to use hospice than NHWs. Cancer studies are mixed, but in meta-analysis were significant for lower relative hospice use in Hispanics (RR 0.96, 95% CI: 0.94-0.99; z=3.01; p=.003). It remains unclear whether using census and insurance data in statistical analysis provides valid results since the Hispanic population is younger, healthier, and less likely to be insured. Health equity in hospice may be better represented by hospice quality rather than hospice enrollment rates.

Integrative Review of the Literature on Hispanics and Hospice.

The provision of optimal end-of-life care to Hispanics receiving hospice care requires familiarity with hospice-specific variables. For example, a preference for nondisclosure of terminal prognosis in some Hispanics is incongruous with traditional hospice practice. In addition, the Spanish word for hospice, "hospicio," has negative connotations about abandonment of loved ones. Added to cultural considerations are socioeconomic considerations. Many marginalized Hispanic individuals may experience distinct challenges when enrolling in hospice due to socioeconomic hardships relating to poverty, citizenship, and lack of insurance. This systematic integrative review examines the research literature on Hispanics and hospice to report on the state of the science for this topic. Reviewed articles were identified systematically using computer research databases and inclusion and exclusion criteria. Of the 21 reviewed articles, many are survey and low-inference qualitative designs with limited validity and trustworthiness. Most survey instruments were not validated for Spanish language or Hispanic culture. None of the qualitative studies included theoretical sampling or follow-up interviews. Few study designs considered heterogeneity within the Hispanic population. Interpreting results cautiously, there is evidence that some Hispanics find some satisfaction with hospice care in spite of cultural incongruities and socioeconomic challenges. Future research calls for intervention studies and high-inference qualitative designs to gain insight into hospice experiences and what constitutes quality hospice care from the perspectives of Hispanic subgroups. Assessing quality and designing interventions for these end-of-life cultural and socioeconomic issues will improve end-of-life care and facilitate the hospice philosophy of promoting emotional growth at end of life.