Hospice decision-making in U.S. mexicans with terminal cancer and their families Public Deposited

Reflecting the postcolonial theoretical framework of the overall study, the dissertation results re-characterize the existing research literature on this topic and provide strong evidence of the importance of mistrust and marginalization during hospice decision-making to some U.S. Mexicans with cancer and their families. A review of the literature reveals that most work on the topic of Hispanics and hospice is Eurocentric. These studies focus mostly on cultural preferences and treat Hispanics as a monolithic population, fostering generalizations and stereotypes. In contrast, the dissertation research recognizes the heterogeneity among Hispanic subgroups and further teases out heterogeneity within the U.S. Mexican population by virtue of marginalization factors and concomitant mistrust. Postcolonial theory further introduces to the study an awareness of power dynamics in the healthcare encounter that is not found in the research literature. Using critical grounded theory as a methodological approach, a substantive grounded theory is developed that describes the process of hospice decision-making in U.S. Mexicans with cancer and their families. Results show that marginalization, by virtue of low income, low education, lack of citizenship, lack of insurance, and geographic ethnic isolation, leads to mistrust and erosion of the therapeutic relationship, which further leads to resisting hospice enrollment. In contrast, U.S. Mexicans who feel Americanized—a sense of belonging—engage in hospice decision-making in a manner similar to Whites, and there appears to be a trusting and therapeutic relationship with the healthcare provider. Among marginalized U.S. Mexicans, hospice resistance is reflected in the U.S. Mexican practices of “We take care of our own,” returning to Mexico, and reliance on alternative healers, hope, and community palliative care. Opposing hospice resistance factors are hospice acceptance factors, which lead to hospice enrollment even among those U.S. Mexicans who may otherwise resist hospice. Hospice resistance factors include caregiver availability, caregiver exhaustion, need for complex nursing care, need for medical equipment, acceptance of dying, rebuilding trust, and being told they have no choice. In the middle of these hospice resistance and acceptance factors is found a “Third Space,” where U.S. Mexicans with terminal cancer and their families seek an end-of-life experience on their own terms. In this “Third Space,” there is hybridity, ambiguity, and conflicting sentiment, which may or may not lead to hospice enrollment. There, the hospice resistance and acceptance factors negotiate with one another until the terminally ill patient dies. The dissertation research highlights the importance of teaching healthcare providers about mitigating legacies of oppression as much as cultural competence, which is the dominant paradigm. In addition, there is a need for future research with marginalized U.S. Mexican populations on the benefits of community palliative care to this population and on the practice of corralling charity hospital patients with terminal illness into hospice.

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  • 0000-0002-1265-6547
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  • rising.margaret.2019.pdf
  • 10.6083/7h149q480
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  • 2019
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  • Rising, M. L. "Hospice decision-making in U.S. mexicans with terminal cancer and their families" (2019). OHSU Digital Collections. rising.margaret.2019.pdf
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