Hostname: page-component-669899f699-qzcqf Total loading time: 0 Render date: 2025-04-29T08:53:33.343Z Has data issue: false hasContentIssue false
  • English
  • Français

Knowledge of advance directive and perceptions of end-of-life care in Chinese-American elders: The role of acculturation

Published online by Cambridge University Press:  11 June 2015

Xiang Gao ,
Fei Sun ,
Eunjeong Ko ,
Jung Kwak  and
Huei-Wern Shen
Xiang Gao*
Affiliation:
School of Social Work, Arizona State University, Phoenix, Arizona
Fei Sun
Affiliation:
School of Social Work, Arizona State University, Phoenix, Arizona
Eunjeong Ko
Affiliation:
School of Social Work, San Diego State University, San Diego, California
Jung Kwak
Affiliation:
School of Social Work, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
Huei-Wern Shen
Affiliation:
School of Social Work, University of Missouri–St. Louis, St. Louis, Missouri
*
Address correspondence and reprint requests to: Xiang Gao, Arizona State University, School of Social Work, Mail Code # 3920, 411 North Central Avene, Phoenix, Arizona 85004. E-Mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This study aimed to describe knowledge of an advance directive (AD) and preferences regarding end-of-life (EoL) care communication, decision making, and designation of surrogates in Chinese-American elders and to examine the role of acculturation variables in AD awareness.

Method:

Survey data were collected through face-to-face interviews on a sample of 385 Chinese-American elders aged 55 or above living in the Phoenix metropolitan area. The choice of language (Mandarin, Cantonese, or English) and place of interview (senior apartments, Chinese senior centers, or homes) was at the respondent's preference. Hierarchical logistic regression analysis was employed to examine the influence of acculturation variables on AD awareness.

Results:

Some 21% of participants had heard about ADs, and only 10% had completed one. Elders with higher acculturation levels (OR = 1.04, p < 0.10) and those residing more than 20 years in the United States (OR = 6.87, p < 0.01) were more likely to be aware of ADs after controlling for the effects of demographics, health, and experiences of EoL care. The majority preferred physicians to initiate AD discussions (84.9%) and identified burdens on families as the most important factor in making EoL decisions (89.3%). About 55.1 % considered daughters as the preferred healthcare surrogate.

Significance of Results:

Acculturation levels influence awareness of an AD, and family values are crucial in EoL care decision making. Cultural factors should be considered in designing and delivering appropriate programs to promote knowledge of EoL care among Chinese-American elders and their families.

Keywords

Chinese-American eldersEnd-of-life careAdvance directiveAcculturation
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 6 , December 2015 , pp. 1677 - 1684
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Administration on Aging (2009). Projected future growth of older adults by race and Hispanic origin. Available from http://www.aoa.gov/AoARoot/Aging_Statistics/future_growth/future_growth.aspx Google Scholar
Blackhall, L.J., Murphy, S.T., Frank, G., et al. (1995). Ethnicity and attitudes toward patient autonomy. The Journal of the American Medical Association, 274, 820–825.Google Scholar
Bito, S., Matsumura, S., Singer, M.K., et al. (2007). Acculturation and end-of-life decision making: Comparisons of Japanese and Japanese-American focus groups. Bioethics, 21(5), 251–262.Google Scholar
Blackhall, L.J., Frank, G., Murphy, S., et al. (2001). Bioethics in a different tongue: The case of truth-telling. Journal of Urban Health, 78, 59–71.CrossRefGoogle Scholar
Bowman, K.W. & Singer, P. A. (2001). Chinese seniors' perspectives on end-of-life decisions. Social Science & Medicine, 53, 455–464.CrossRefGoogle ScholarPubMed
Braun, K.L., Onaka, A.T. & Horiuchi, B.Y. (2001). Advance directive completion rates and end-of-life preferences in Hawaii. Journal of the American Geriatrics Society, 49(12), 1708–1713.Google Scholar
Eleazer, G.P., Hornung, C.A., Egbert, C.B., et al. (1996). The relationship between ethnicity and advance directives in a frail older population. Journal of the American Geriatrics Society, 44, 938–943.CrossRefGoogle Scholar
Fagerlin, A., Ditto, P.H., Hawkins, N.A. et al. (2002). The use of advance directives in end-of-life decision making problems and possibilities. American Behavioral Scientist, 46(2), 268–283.Google Scholar
Fang, M.L., Malcoe, L.H., Sixsmith, J., et al. (2014). Exploring traditional end-of-life beliefs, values, expectations, and practices among Chinese women living in England: Informing culturally safe care. Palliative & Supportive Care, 27, 1–14.Google Scholar
Gallagher-Thompson, D., Gray, H.L., Tang, P.C.Y., et al. (2007). Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: Results of a pilot study. The American Journal of Geriatric Psychiatry, 15(5), 425–434.CrossRefGoogle ScholarPubMed
Gupta, R. & Yick, A.G. (2001). Preliminary validation of the acculturation scale on Chinese Americans. Journal of Social Work Research and Evaluation, 2(1), 43–56.Google Scholar
Hall, E.T. (1976). How cultures collide. Psychology Today, 10, 66–75.Google Scholar
Ho, Z.J.M., Radha Krishna, L.K. & Yee, C.P.A. (2010). Chinese familial tradition and Western influence: A case study in Singapore on decision making at the end of life. Journal of Pain and Symptom Management, 40(6), 932–937.Google Scholar
Hornung, C.A., Eleazer, G.P., Stroghers, H.S., et al. (1998). Ethnicity and decision-makers in a group of frail older people. Journal of the American Geriatrics Society, 46, 280–286.Google Scholar
Huang, W. (2003). Chinese Americans acculturation scale. Doctoral dissertation. Kent, Ohio: Kent State University.Google Scholar
Hwang, W.C. & Ting, J.Y. (2008). Disaggregating the effects of acculturation and acculturative stress on the mental health of Asian Americans. Cultural Diversity & Ethnic Minority Psychology, 14(2), 147.Google Scholar
Ko, E. & Lee, J. (2010). Completion of advance directives among Korean American and non-Hispanic white older adults. Research on Aging, 32(5), 618–644.CrossRefGoogle Scholar
Kwak, J. & Haley, W.E. (2005). Current research findings on end-of-life decision making among racially or ethnically diverse groups. The Gerontologist, 45(5), 634–641.Google Scholar
Kwak, J. & Salmon, J.R. (2007). Attitudes and preferences of Korean-American older adults and caregivers on end-of-life care. Journal of the American Geriatrics Society, 55(11), 1867–1872.CrossRefGoogle ScholarPubMed
Kwak, J., Ko, E.J. & Kramer, B.J. (2014). Advance care planning practice with elders of diverse ethnic backgrounds and needs. Health & Social Care in the Community, 22, 169–177.Google Scholar
Lugo, L., Cooperman, A., Funk, C., et al. (2012). Asian Americans: A mosaic of faith. A Pew Research Report. Available from the Pew Forum on Religion and Public Life: http://www.pewforum.org.Google Scholar
Matsumura, S., Bito, S., Liu, H., et al. (2002). Acculturation of attitudes toward end-of-life care. Journal of General Internal Medicine, 17(7), 531–539.Google Scholar
Morrison, R.S. & Meier, D. (2004). High rates of advance care planning in New York City's elderly population. Archives of Internal Medicine, 164, 2421–2426.CrossRefGoogle ScholarPubMed
Morrison, R.S., Zayas, L.H., Mulvihill, M., et al. (1998). Barriers to completion of health care proxies: An examination of ethnic differences. Archives of Internal Medicine, 158(22), 2493–2497.CrossRefGoogle ScholarPubMed
Murphy, C.P., Sweeney, M.A. & Chiriboga, D. (2000). An educational intervention for advance directives. Journal of Professional Nursing, 16(1), 21–30.CrossRefGoogle ScholarPubMed
Murphy, S.T., Palmer, J.M., Azen, S., et al. (1996). Ethnicity and advance care directives. The Journal of Law, Medicine & Ethics, 24(2), 108–117.Google Scholar
Phipps, E., True, G., Harris, D., et al. (2003). Approaching the end of life: Attitudes, preferences, and behaviors of African-American and white patients and their family caregivers. Journal of Clinical Oncology, 21(3), 549–554.Google Scholar
Vaughn, G., Kiyasu, E. & McCormick, W.C. (2000). Advance directive preferences among subpopulations of Asian nursing home residents in the Pacific Northwest. Journal of the American Geriatrics Society, 48, 554–557.CrossRefGoogle ScholarPubMed
Wittenberg-Lyles, E., Villagran, M.M. & Hajek, C. (2008). The impact of communication, attitudes, and acculturation on advance directives decision making. Journal of Ethnic and Cultural Diversity in Social Work, 17(4), 349–364.Google Scholar
Xu., Y. (2007). Death and dying in the Chinese culture: Implications for health care practice. Home Health Care Management & Practice, 19(5), 412–414.Google Scholar