Table 1.
Important themes to address when providing counseling services to Latino cancer patients
| Categories | Themes | Illustrative quotes |
|---|---|---|
| Emotional and distress symptoms | Concerns about quality of life | G: “The mourning for the loss of personal and economic independence. Feeling useless.” FS: “Fear of physical and emotional suffering.” CS: “Many of these patients have been reluctant to share information with family/friends due to sense of shame about illness.” |
| Grief (G) | ||
| Fear of suffering (FS) | ||
| Cancer stigma (CS) | ||
| Emotional response | ||
| Coping strategies addressed during counseling | Acceptance (A) | A: “In the acceptance of the physical limitations that progress with the disease, which creates difficulty in being able to let oneself be helped by their relatives or loved ones.” EC: “Carry out an elaborative synthesis of what life has been like to say goodbye slowly.” |
| Self-care | ||
| Existential coping (EC) | ||
| Resilience | ||
| Maintain hope | ||
| Patients’ autonomy and decision-making | Patients’ autonomy (PA) | PA: “Fulfill the wishes of the patient, that the patient makes the decisions while able to and not the family, that the decisions made by the patient are respected.” |
| Experience with cancer and disease trajectory | Prognosis | CT: “Managing treatment expectations.” CAD: “Losses and changes after diagnosis.” |
| Cancer treatment (CT) | ||
| Survivorship | ||
| Changes after diagnosis (CAD) | ||
| Palliative care needs and issues | Advanced directives | PC: “Goals of care discussions is also an important topic.” HC: “For many, hospice does not have a good connotation.” HC: “Preparing patients and families for hospice care.” |
| Palliative care (PC) | ||
| Hospice care (HC) | ||
| End of life | Fear of death and dying (FD) | FD: “Fear of death, particularly fear if suffering from physical symptoms or bedridden.” TAD: “For my culture in particular, talking about the issues of death is the biggest challenge, about grief, the farewell.” UB: “Pending issues: family, economic, legal and emotional problems.” UB: “Take care that the main relationships of the patient are resolved.” |
| Talking about death (TAD) | ||
| Dying | ||
| End of life planning | ||
| Unfinished business (UB) | ||
| Education and knowledge | Education and access to resources (EAR) | EAR: “Education about these resources.” UKC: “Quality information about cancer and its treatment.” UKC: “Some patients are unclear about diagnosis, staging, or the name of their particular cancer.” |
| Understanding or knowledge about the cancer (UKC) | ||
| Nutrition/diet information | ||
| Communication with health care team | Communication with medical team | MHPC: “Importance of venting emotions with provider.” |
| Mental health provider communication (MHPC) | ||
| Access to health and psychosocial services | Geographic barriers | AHPC: “Challenging where patients can locate services in the area to meet their needs (both medical and psycho-social).” MHS: “I think there is already stigma among many members of this community about receiving formal mental health treatment and now adding medical problems further adds to perceived stigma of seeking treatment.” |
| Access to health and psychosocial care (AHPC) | ||
| Mental health treatment stigma (MHS) | ||
| Physical issues | Physical limitations | PM: “Offer alternatives and remove stigmas about pain.” PM: “The connection body-mind-spirit in dealing with pain.” |
| Pain management (PM) | ||
| Self- and body image | ||
| Family and caregiver issues | Dealing with children | FI: “I have found that Latinos often want to focus on their actual cancer diagnosis, treatments, prognosis, and how this is impacting their family and social relationships, work situations, and financial situations.” FD: “It they discuss these issues, it seems often in the context of their family relationships/situations. For example, ‘what will happen to my family after I’m gone?” FC: “How and when they communicate with their loved ones about death and dying. How and when they communicate about their loved ones about needs and expectations at end of life.” FS: “Think focusing on the family being diagnosed is pivotal and not just focus solely on the patient with the cancer diagnosis. Many times, the pt. is equally worried about their family and their health/prognosis.” |
| Family impact (FI) | ||
| Family dynamics (FD) | ||
| Family communication (FC) | ||
| Family support (FS) | ||
| Socioeconomic issues | Socioeconomic issues (SEI) | SEI: “They do not have the financial resources to pay for some mental health services.” SEI: “I have found that Latinos often want to focus on their actual cancer diagnosis, treatments, prognosis and how this is impacting their … financial situations.” |
| Religiosity and/or spirituality issues | Religiosity and/or spirituality issues (RS) | RS: “Fear of being punished by a higher power.” RS: “Desire for spiritual connection.” |