Supportive Care in Cancer

, Volume 21, Issue 5, pp 1233–1239 | Cite as

Advance care planning among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis

  • Iraida V. CarrionEmail author
  • Frances R. Nedjat-Haiem
  • Dinorah Martinez-Tyson
  • Heide Castañeda
Original Article



Limited knowledge exists pertaining to advance care planning (ACP) among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis living in Central Florida, in the USA. The purpose of the study is to identify factors that facilitated the completion of ACP and decisions making patterns among the three groups of Latinas.


The research method used was an exploratory qualitative in-depth open-ended semi-structured interview with a grounded theoretical approach and thematic analysis. The interviews were conducted in Spanish with a purposeful sample of 45 Latinas (15 in each group) diagnosed with cancer.


A total of ten women (22 %) in the study documented at least one form of ACP. Thirty-five women identified obstacles to accessing information regarding ACP, relating this to insurance and financial factors. Among the Colombian women, one completed a living will, health care surrogate, and power of attorney (all forms of ACP), and three just a living will. Two Puerto Rican women completed all, two a living will, and one both a living will and an enduring power of attorney. Only one Mexican woman completed a living will.


This study identifies a knowledge gap regarding ACP among Latina women with cancer diagnosis living in Central Florida, in the USA. Differences between the three groups exist as a result of migration/immigration history, family support, education, English language proficiency, income, knowledge gaps, and information ascertained by medical and health professionals. These differences contribute to their readiness, receptiveness, and willingness to engage in documenting a living will, a health care surrogate, and an enduring power of attorney for health decisions.


Advance care planning Latina Cancer Health decisions 



The authors would like to thank Dr. Lee Green and Dr. Richard Roetzheim for their support and the Latina women who generously participated in the study. They also thank Ingrid Asmar and Milagros Porter for all their contributions as research assistants. This study was supported by the Division of Population Sciences, H. Lee Moffitt Cancer Center and Research Institute and the Division for Equal Health, University of South Florida in Tampa, FL, National Institute of Health grant number P20 MDD00375-01.


  1. 1.
    Braun KL, Piesch JH, Blanchette PL (eds) (2000) Cultural issues in end-of-life decision making. Sage, Thousand OaksGoogle Scholar
  2. 2.
    Wright AA, Zhang B, Ray A et al (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300(14):1665–1673PubMedCrossRefGoogle Scholar
  3. 3.
    Lawsin C, Erwin D, Bursac Z, Jandorf L (2011) Heterogeneity in breast and cervical cancer screening practices among female Hispanic immigrants in the United States. J Immigr Minor Health 13:834–841PubMedCrossRefGoogle Scholar
  4. 4.
    Fernández LE, Morales A (2007) Language and use of cancer screening services among border and non-border Hispanic Texas women. Ethn Health 12:245–263PubMedCrossRefGoogle Scholar
  5. 5.
    Sanchez-Birkhead AC, Kennedy HP, Callister LC, Miyamoto TP (2011) Navigating a new health culture: experiences of immigrant Hispanic women. J Immigr Minor Health 13:1168–1174PubMedCrossRefGoogle Scholar
  6. 6.
    Pinheiro PS, Sherman RL, Trapido EJ, Fleming LD, Huang Y, Gomez-Marin O et al (2009) Cancer incidence in first generation U.S. Hispanics: Cubans, Mexicans, Puerto Ricans, and New Latinos. Cancer Epidem Biomar 18:2162–2169CrossRefGoogle Scholar
  7. 7.
    Ennis SR, Ríos-Vargas M, Albert NG (2011) The Hispanic population: 2010. (C2010BR-04). Census Bureau, Washington, DC. February 26 2012 from
  8. 8.
    American Cancer Society (2011) Cancer facts and figures for Hispanics/Latinos 2009–2011. February 26, 2012, from
  9. 9.
    US Census American Fact Finder 2011 (2012) February 26, 2012, from
  10. 10.
    The Pew Hispanic Center (2011) Hispanics of Colombian origin in the United States, from
  11. 11.
    Gany FM, Herrera AP, Avallone M, Changrani J (2006) Attitudes, knowledge, and health-seeking behaviors of five immigrant minority communities in the prevention and screening of cancer: a focus group approach. Ethn Health 11:19–39PubMedCrossRefGoogle Scholar
  12. 12.
    Smith AK, McCarthy EP, Paulk E, Balboni TA, Maciejewski PK, Block SD et al (2008) Racial and ethnic differences in advance care planning among patients with cancer: impact of terminal illness acknowledgment, religiousness, and treatment preferences. J Clin Oncol 26:4131–4137PubMedCrossRefGoogle Scholar
  13. 13.
    Kulkarni SP, Karliner LS, Auerbach AD, Perez-Stabl EJ (2011) Physician use of advance care planning discussions in a diverse hospitalized population. J Immigr Minor Health 13:620–624PubMedCrossRefGoogle Scholar
  14. 14.
    Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC (2004) Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315–321PubMedCrossRefGoogle Scholar
  15. 15.
    Werner-Lin A (2010) Building the cancer family: family planning in the context of inherited breast and ovarian cancer risk. J Soc Social Work Res 1:14–27CrossRefGoogle Scholar
  16. 16.
    Daaleman TP, Emmett CP, Dobbs D, Williams SW (2008) An exploratory study of advance care planning in seriously ill African-American elders. J Natl Med Assoc 100:1457-62, from Google Scholar
  17. 17.
    Hahn M (2003) Advanced directives and patient patient–physician communication. JAMA 289:96PubMedCrossRefGoogle Scholar
  18. 18.
    Mcgarvey EL, Clavet GJ, Johnson JB, Butler A, Cook KO, Pennino B (2003) Cancer screening practices and attitudes: comparison of low-income women in three ethnic groups. Ethn Health 8:71–82PubMedCrossRefGoogle Scholar
  19. 19.
    Carrion IV (2010) Communicating terminal diagnosis to Hispanic patients. Palliative Support Care 8:117–123CrossRefGoogle Scholar
  20. 20.
    Nedjat-Hajem F, Carrion IV, Ell K, Palinkas L (2011) Navigating the advanced cancer experience of underserved Latinas. Support Care Cancer 20(12):3095–3104Google Scholar
  21. 21.
    Surbone A (2006) Cultural aspects of communication in cancer care. Recent Res Cancer 168:91–104CrossRefGoogle Scholar
  22. 22.
    Gehlert S, Colditz GA (2011) Cancer disparities: unmet challenges in the elimination of disparities. Cancer Epidem Biomar 20:1809–1814CrossRefGoogle Scholar
  23. 23.
    Kagawa-Singer M, Dadia AV, Yu MC, Surbone A (2010) Cancer, culture, and health disparities: time to chart a new course? CA Cancer J Clin 60(1):12–39PubMedCrossRefGoogle Scholar
  24. 24.
    Yoo GJ, Levine EG, Aviv C, Ewing C, Au A (2010) Older women, breast cancer, and social support. Support Care Cancer 18:1521–1530PubMedCrossRefGoogle Scholar
  25. 25.
    LaVeist TA (2000) On the study of race, racism, and health: a shift from description to explanation. Int J Health Serv 30:217–219PubMedCrossRefGoogle Scholar
  26. 26.
    McMullin JM, De Alba I, Chávez LR, Hubbell FA (2005) Influence of beliefs about cervical cancer etiology on pap smear use among Latina immigrants. Ethn Health 10:3–18PubMedCrossRefGoogle Scholar
  27. 27.
    Heron M (2011) Deaths: leading causes for 2007. Natl Vital Stat Rep 59(8):1–95PubMedGoogle Scholar
  28. 28.
    Hernandez MN, Fleming LE, MacKinnon JA, Lee DJ (2010) Cancer in Florida Hispanics 1989–2006. Florida Cancer Data System, Miami, FL. From
  29. 29.
    Martinez-Tyson D, Barnett Pathak E, Soler-Vila H, Flores A (2009) Looking under the Hispanic umbrella: cancer mortality among Cubans, Mexicans, Puerto Ricans and other Hispanics in Florida. J Immigr Minor Health 114:249–257CrossRefGoogle Scholar
  30. 30.
    Bruera E, Sweeney C, Calder K, Palmer L, Benisch-Tolley S, Chochinov HM (2001) Patient preferences versus physicians’ perceptions of treatment decisions in cancer care. J Clin Oncol 19:2883–2885PubMedGoogle Scholar
  31. 31.
    Kleinman A, Benson P (2006) Anthropology in the clinic: the cultural competency problem and how to fix it. PLoS Medicine 3:e294. doi: 10.1371/journal.pmed.0030294 PubMedCrossRefGoogle Scholar
  32. 32.
    Patton MQ (2002) Qualitative research and evaluation methods, 3rd edn. Sage, Thousand OaksGoogle Scholar
  33. 33.
    Morse JM, Stern PN, Corbin J, Bowers B, Charmaz K, Clarke A (2009) Grounded theory: the second generation. Left Coast, Walnut CreekGoogle Scholar
  34. 34.
    Brislin RW (1970) Back-translation for cross-cultural research. J Cross Cult Psychol 1:85–216CrossRefGoogle Scholar
  35. 35.
    Crabtree BF, Miller WL (1992) A temple approach to text analysis: developing and using codebooks. In: Crabtree BF, Miller WL (eds) Doing qualitative research. Sage, Thousand Oaks, pp 93–109, Vol 3Google Scholar
  36. 36.
    Sudore RL, Landefeld CS, Barnes DE, Lindquist K, Williams BA, Brody R, Schillinger D (2007) An advance directive redesigned to meet the literacy level of most adults: a randomized trial. Patient Educ Couns 69:165–195PubMedCrossRefGoogle Scholar
  37. 37.
    Goldstein NE, Mehta D, Teitelbaum E, Bradley EH, Morrison S (2008) “It’s like crossing a bridge” complexities preventing physicians from discussing deactivation of implantable defibrillators at the end of life. J Gen Intern Med 23:2–6PubMedCrossRefGoogle Scholar
  38. 38.
    Ward E, Jemal A, Cokkinides V, Singh GK, Cardines C, Ghafoor A et al (2004) Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 54:78–93PubMedCrossRefGoogle Scholar
  39. 39.
    Tulsky JA (2005) Interventions to enhance communication among patients, providers, and families. J Palliative Med 8(Supplement1):95–102Google Scholar
  40. 40.
    Oorschot B, Schuler M, Simon A, Flentje M (2012) Advance directives: prevalence and attitudes of cancer patients receiving radiotherapy. Support Care Cancer. doi: 10.1007/s00520-012-1394-y

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Iraida V. Carrion
    • 1
    Email author
  • Frances R. Nedjat-Haiem
    • 2
  • Dinorah Martinez-Tyson
    • 3
  • Heide Castañeda
    • 4
  1. 1.School of Social WorkUniversity of South FloridaTampaUSA
  2. 2.Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesUSA
  3. 3.Department of Child and FamilyUniversity of South FloridaTampaUSA
  4. 4.Department of AnthropologyUniversity of South FloridaTampaUSA

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