The role of acculturation in end-of-life outcomes for Latino advanced cancer patients.

Abstract

6117 Background: The role of acculturation (AC) in the end-of-life (EOL) outcomes of Latino cancer patients is unknown. Methods: Fifty-eight self-reported Latino, Stage IV cancer patients and their caregivers participated in a U.S. multisite, prospective cohort study from September 2002-August 2008. Adapted from Cuellar's work, AC score (ACS) was measured using Brief AC Scale (5, 5-point items) for patients and United States Acculturation Scale (19, 5-point items, USAS) for caregivers. All participants were interviewed at baseline; caregiver post-mortem interviews provided location and quality of death. Results: Sixty-nine percent of patients were born outside the U.S. (predominantly Mexico), with the majority (89.7%) recruited from Texas. Mean ACS score was 10.2 (SD 6.7, range 5-25); mean USAS score was 44.0 (SD 20.4, range 21-80). The insured (ACS mean [SD]: 9.4 [6.3] vs. 14.2 [7.3], p = 0.04), those with no religious affiliation (F = 5.1, p = 0.01), and patients and caregivers with higher educational attainment (ACS r = 0.40, p = 0.002; USAS r = 0.44, p = 0.001) were more highly acculturated. ACS did not vary by baseline patient health/demographics, therapeutic alliance, EOL care preferences or discussions. More acculturated patients were more likely to die at home or in a hospice facility after controlling for confounders (OR 1.3, p = 0.005). Less acculturated caregivers were more likely to rate the quality of death positively (0.04, p = 0.05), however this was attenuated after controlling for location of death (0.02, p = 0.35). Conclusions: This study suggests level of acculturation may influence the location of death of Latino advanced cancer patients, but not EOL preferences or caregiver perception of death quality. No significant financial relationships to disclose.