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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]
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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 

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