By Stacey Kusterbeck
Susanny J. Beltran, PhD, MSW, and colleagues noticed that older Latinos consistently completed advance care planning documentation less frequently compared to the general population. Additionally, advance care planning information often is not available in Spanish, creating challenges both in community settings and when patients are admitted to the hospital.
“This leaves individuals to learn about it during emergencies, when decision-making can be more challenging,” says Beltran, an assistant professor in the School of Social Work at University of Central Florida.
Beltran and colleagues evaluated an educational intervention to see if it would improve advance care planning readiness and knowledge of older Latino adults.1 The researchers surveyed older Latinos attending community wellness centers about their knowledge of, and attitudes about, advance care planning, hospice, and palliative care. After the intervention, participants had higher advance care planning knowledge, better understanding of care options, and more positive attitudes about palliative and hospice care. Beltran says that clinicians should take these steps to ensure equitable access to end-of-life care planning:
- prioritize patient autonomy;
- engage in culturally sensitive communication that respects family dynamics;
- proactively address language, literacy, and educational gaps.
“Some individuals may not be familiar with care options due to varying levels of acculturation and prior experiences with the healthcare system,” observes Beltran.
Hospital ethicists can help in these ways, offers Beltran:
Advocating for institutional policies that ensure early identification of patients who might benefit from advance care planning. Advance care planning often is reserved for patients with serious or terminal illnesses. Implementing standardized policies could help introduce the topic earlier, such as during routine hospital admissions. “This approach would address situations where existing advance care planning processes are inconsistently applied, ensuring that eligible patients are identified early, and no one falls through the cracks,” says Beltran.
Providing training for healthcare staff on culturally sensitive communication strategies to better engage Spanish-speaking and underserved patients in advance care planning. “Ethicists could tailor this training to specific units, such as oncology or palliative care, where advance care planning discussions are particularly relevant,” suggests Beltran. Culturally sensitive strategies include using bilingual staff or interpreters, avoiding medical jargon, respecting cultural preferences for family involvement in decision-making, and incorporating culturally relevant metaphors or examples when discussing advance care planning.
Collaborating with organizations to provide culturally appropriate advance care planning education and resources beyond the hospital setting. “This would advance continuity of care, and foster trust in the community,” says Beltran. Ethicists could connect with community organizations (such as senior centers, churches, or advocacy groups) to provide advance care planning education, tailored to the needs of Spanish-speaking and underserved populations. Ethicists also could train community leaders to deliver advance care planning education to older Latinos in a culturally relevant manner. “This strategy has the potential for significant impact, as it reaches individuals before hospitalization and builds trust within the community,” says Beltran.
Currently, the researchers are developing a protocol for training community wellness center staff to deliver the intervention, ensuring its long-term sustainability and broader reach. “Ethicists’ expertise could be valuable in refining aspects of the training to ensure alignment with both ethical principles and community needs,” says Beltran.
Reference
1. Beltran SJ, Molina O, Chapple R. Enhancing end-of-life care knowledge among older Spanish-speaking adults: Results from a pilot educational intervention on advance care planning and care options. Am J Hosp Palliat Care. 2025;42(1):85-93.
Susanny J. Beltran, PhD, MSW, and colleagues noticed that older Latinos consistently completed advance care planning documentation less frequently compared to the general population. They evaluated an educational intervention to see if it would improve advance care planning readiness and knowledge of older Latino adults.
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