The intricacies of illiteracy, an indigenous language, and religious beliefs on oncology and palliative care: Perspectives from Paraguayan healthcare providers.

Abstract

e24067 Background: Paraguay is a country with two official languages, Spanish and Guarani. 34.7% of the population speaks both, while 33.4% of the population speaks only the indigenous language. The country also has a rate of illiteracy of 6.8%. Religion, present in 97.4% of the population—mostly Catholicism—serves as a unifying cultural element across the country. The project aims to identify and address communication challenges faced by healthcare professionals in their daily oncologic practice. Methods: This was a pilot, cross-sectional, descriptive study. Physicians, Nurses and Psychologists working in the main cancer centers nationwide were questioned, using an original semi-structured survey as an instrument. Results: Sixty-four healthcare providers participated in the study, 46.9% were specialist physicians, 15.6% fellows, 31.3% nurses and 6.3% psychologists. Barriers were identified such as denial, language discordance, and lack of comprehension. Overall 48.4% of participants were fluent in Guarani, the rest were non-Guarani speakers or had rudimentary knowledge. Additionally, 36% of participants reported using interpreters, relying on family members and other healthcare professionals. Regarding communication difficulties, 56.3% of professionals noted that Guarani sometimes hinders patients’ understanding of medical information and 62.5% identified illiteracy as occasionally affecting patient care, primarily impacting the understanding of prognosis and diagnosis (76.6%). 29.7% claimed seeing 2-5 patients weekly that struggle to comprehend their illness or treatment, to tackle this 71.9% constantly repeat the same information in every visit. As for religion, 92.2% agreed that spiritual beliefs significantly influence end-of-life decisions with 57.8% recommending staff training in religious counseling. Conclusions: Guarani and illiteracy create barriers to effective communication in palliative care. Following suggestions from participants, strategies to mitigate them include the addition of a member who speaks the language and training staff in oral and visual communication. Even so, training programs should be established to enhance language-concordant care for all professionals. Additionally, incorporating religion and spirituality into palliative care can provide patients with deeper emotional support and help them find peace during such a challenging time. This pilot study could serve as a model for other specialties nationwide.