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Discussing End-of-Life Issues in Mexico With Older People and Family Caregivers

Nance, Douglas C. MSN; May, Maria Isabel Rivero EdD; Padilla, Luis Flores Dr. en CSP; Nava, Mario Moreno DPA; Pantoja, Alma Laura Deyta LEE

Journal of Hospice & Palliative Nursing: October 2015 - Volume 17 - Issue 5 - p 427–433
doi: 10.1097/NJH.0000000000000180
Feature Articles

Older persons often lack the assurance that their needs, wishes, and preferences will be respected. This is the first project in Mexico to involve older adults and family caregivers in end-of-life care discussions. The aim is to better understand concerns around end-of-life issues. This qualitative, phenomenological study used listening events held in 6 culturally, socially, and geographically diverse areas to discuss end-of-life issues with older adults and family caregivers. Framework analysis was used to classify and organize data according to key themes, concepts, and emergent categories. Data were reviewed and discussed until consensus was reached. A total of 121 persons participated. Six major themes were expressed: (1) lack of knowledge of advance directives, (2) little concern regarding pain management and do-not-resuscitate orders and opposition to euthanasia, (3) need for home care training, (4) male caregivers, (5) importance of religious faith, and (6) preferences of dying. Important information was obtained about preferences and concerns of older adults and their caregivers, and a discussion forum was provided. Participants wanted respect from the health care team, to be accompanied by family and religious leaders, and to have a pleasant environment in their final days. Caregivers coped using reciprocity, a work-oriented attitude, pride in caregiving, and faith.

Douglas C. Nance, MSN, is professor/researcher at Universidad de la Sierra Sur, Instituto de Investigación Sobre la Salud Pública, Miahuatlán de Porfirio Díaz, Oaxaca, Mexico.

Maria Isabel Rivero May, EdD, is professor, Instituto Mexicano del Seguro Social, School of Nursing, Universidad Autonoma de la Yucatan, Merida, Yucatan.

Luis Flores Padilla, Dr. en CSP, is researcher, Unidad de Investigacion Epidemiologica y en Servicios de Salud, Instituto Mexicano del Seguro Social Ciudad Juarez, Chihuahua, Mexico.

Mario Moreno Nava, DPA, is chief, Division of Nursing Programs, Instituto Mexicano del Seguro Social, Mexico, DF, Mexico.

Alma Laura Deyta Pantoja, LEE, is professor, Education Division, Instituto Nacional de Geriatria, Mexico, DF, Mexico.

Address correspondence to Douglas C. Nance MSN, Universidad de la Sierra Sur, Instituto de Investigación Sobre la Salud Pública, Av. Guillermo Rojas Mijangos s/n esq. Av. Universidad, Col. Ciudad Universitaria, Miahuatlán de Porfirio Díaz, Oaxaca C.P. 70800 (

Douglas C. Nance received partial travel support from the Instituto Nacional de Geriatria.

The authors have no conflicts of interest to disclose.

© 2015 by The Hospice and Palliative Nurses Association.