Gender Differences in End-of-Life Care in Older Mexican American Adults

2020 ◽  
Vol 35 (4) ◽  
pp. 256-266
Author(s):  
Evangeline M. Ortiz-Dowling ◽  
Janice D. Crist ◽  
Kimberly Shea ◽  
Linda R. Phillips
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Health Care Professionals ◽  
Mexican Americans ◽  
Mexican American ◽  
A Priori ◽  
The United States ◽  
Review Articles ◽  
And Gender ◽  
Eol Care

Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing articles were excluded. Of the 345 unduplicated articles identified in our electronic search and the 47 identified through review articles, 22 met the inclusion criteria. Content analysis was conducted using a priori codes from the Ethno-Cultural Gerontological Nursing Model (ECGNM). Only 8 (36%) of the 22 articles reported on MA older adults’ gendered experiences related to EOL decision-making. Results indicate an association between gender and EOL decision-making. As the older MA population grows, tackling disparities in EOL services use requires attention to how culture and gender influence EOL decision-making and care.

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

2015 ◽  
Vol 13 (6) ◽  
pp. 1677-1684 ◽  
Author(s):  
Xiang Gao ◽  
Fei Sun ◽  
Eunjeong Ko ◽  
Jung Kwak ◽  
Huei-Wern Shen
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Directive ◽  
Chinese American ◽  
The United States ◽  
Face To Face ◽  
Hierarchical Logistic Regression ◽  
Phoenix Metropolitan Area ◽  
Eol Care

ABSTRACTObjective: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.

Good Neighbor in the American Historical Imagination: Mexican American Intellectual Thought in the Fight for Civil Rights, 1930s–1940s

2021 ◽  
Author(s):  
Natalie Mendoza
Keyword(s):  
United States ◽  
Civil Rights ◽  
Identity Formation ◽  
Mexican Americans ◽  
Mexican American ◽  
The United States ◽  
Historical Narrative ◽  
Historical Imagination ◽  
American Intellectual ◽  
Good Neighbor

Abstract This article argues that historical narrative has held a significant role in Mexican American identity formation and civil rights activism by examining the way Mexican Americans in the 1930s and 1940s used history to claim full citizenship status in Texas. In particular, it centers on how George I. Sánchez (1906–1972), a scholar of Latin American education, revised historical narrative by weaving history and foreign policy together through a pragmatic lens. To educators and federal officials, Sánchez used this revisionist history to advocate for Mexican Americans, insisting that the Good Neighbor policy presented the United States with the chance to translate into reality the democratic ideals long professed in the American historical imagination. The example of Sánchez also prompts us to reexamine the historiography in our present day: How do we define the tradition and trajectory of Mexican American intellectual thought in U.S. history? This article posits that when Sánchez and other Mexican Americans thought about their community’s collective identity and civil rights issues through history, they were contributing to a longer conversation driven by questions about identity formation and equality that first emerged at the end of the U.S. War with Mexico in 1848. These questions remain salient in the present, indicating the need for a historiographic examination that will change how we imagine the tradition of intellectual thought in the United States.

How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care: a qualitative study

2021 ◽  
pp. medethics-2020-106690
Author(s):  
Sarah Rosenwohl-Mack ◽  
Daniel Dohan ◽  
Thea Matthews ◽  
Jason Neil Batten ◽  
Elizabeth Dzeng
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
The United States ◽  
Ethical Framework ◽  
Shared Decision ◽  
Life Care ◽  
Best Interest ◽  
Ethical Frameworks

ObjectivesThe end of life is an ethically challenging time requiring complex decision-making. This study describes ethical frameworks among physician trainees, explores how these frameworks manifest and relates these frameworks to experiences delivering end-of-life care.DesignWe conducted semistructured in-depth exploratory qualitative interviews with physician trainees about experiences of end-of-life care and moral distress. We analysed the interviews using thematic analysis.SettingAcademic teaching hospitals in the United States and United Kingdom.ParticipantsWe interviewed 30 physician trainees. We purposefully sampled across three domains we expected to be associated with individual ethics (stage of training, gender and national healthcare context) in order to elicit a diversity of ethical and experiential perspectives.ResultsSome trainees subscribed to a best interest ethical framework, characterised by offering recommendations consistent with the patient’s goals and values, presenting only medically appropriate choices and supporting shared decision-making between the patient/family and medical team. Others endorsed an autonomy framework, characterised by presenting all technologically feasible choices, refraining from offering recommendations and prioritising the voice of patient/family as the decision-maker.ConclusionsThis study describes how physician trainees conceptualise their roles as being rooted in an autonomy or best interest framework. Physician trainees have limited clinical experience and decision-making autonomy and may have ethical frameworks that are dynamic and potentially highly influenced by experiences providing end-of-life care. A better understanding of how individual physicians’ ethical frameworks influences the care they give provides opportunities to improve patient communication and advance the role of shared decision-making to ensure goal-aligned end-of-life care.

Call the Rezadora: Aiding Latino Families at the End of Life

2021 ◽  
pp. 154041532110289
Author(s):  
Kim L. Larson ◽  
Graziella D. Jewell ◽  
Maria Fernanda Maldonado ◽  
Morgan E. Braxton ◽  
Lee Ann Johnson
Keyword(s):  
End Of Life ◽  
Single Case ◽  
The United States ◽  
Latino Families ◽  
Holistic View ◽  
Serious Illness ◽  
Care Services ◽  
Palliative Care Teams ◽  
Eol Care

Introduction: The rezadora, a lay spiritual leader, provides support to Latino families as they provide end-of-life (EOL) care for loved ones. The purpose of this study was to learn about the work of the rezadora in Guatemala as a resource for Latinos with serious illness in the United States. Methods: An ethnographic exploratory case study was conducted during summer 2018 in rural Guatemala. We interviewed three rezadoras who resided in two villages. The study yielded two cases, the single case and the paired case, which allowed for a holistic view of how the rezadora serves the community. Results: Content and thematic analysis led to two themes: Essence of being called and Power of prayerful song. Essence of being called was represented by the prominence of the rezadora and their perpetual faith work. Power of prayerful song was characterized through the mission, customs, and the presence of the rezadora. A good death was aided by the rezadora in this context. Conclusions: As the Latino population ages in place, the need for palliative and EOL care services will increase. Lay spiritual leaders could enhance the palliative care teams in these communities and improve the quality of life for Latinos with serious illness.

Improving the Quality of Care across All Settings

2019 ◽  
pp. 573-605
Author(s):  
Marilyn Bookbinder ◽  
Romina Arceo ◽  
James T. McDaniel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
The United States ◽  
Healthcare Settings ◽  
National Priority ◽  
Hospice And Palliative Care ◽  
Eol Care ◽  
Clinician Assessment ◽  
Care Path

This chapter provides perspectives on quality-based initiatives in the United States across healthcare settings and populations and describes their impact on patient, professional, and system outcomes. The authors discuss the need for quality improvement (QI) at end of life, QI principles, and the models, methods, and tools most frequently used. Also described are areas of national priority for improving end-of-life (EOL) care. A care-path for the end of life is used to illustrate a QI effort and the FOCUS_PDSA method and to encourage use of specific tools for improving EOL care, including respiratory distress, and a clinician assessment of EOL care using The Joint Commission (TJC) tracer methodology. The authors review the linkages between QI and practice changes in hospitals and hospices that ultimately lead to improved EOL care and close with examples of how nurses are providing leadership in the field of quality hospice and palliative care.

Supporting Pediatric Patients and Their Families at the End of Life: Perspectives From Bereaved Parents

2020 ◽  
Vol 37 (12) ◽  
pp. 1009-1015
Author(s):  
Laura K. Sedig ◽  
Jessica L. Spruit ◽  
Trisha K. Paul ◽  
Melissa K. Cousino ◽  
Harlan McCaffery ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Health Care Providers ◽  
Life Experiences ◽  
The United States ◽  
Parental Perception ◽  
Care Providers ◽  
Supportive Services ◽  
Bereaved Parents ◽  
Actual Decision

Background: Cancer remains the leading cause of death by disease for children in the United States. It is imperative to optimize measures to support patients and families facing the end of a child’s life. This study asked bereaved parents to reflect on their child’s end-of-life care to identify which components of decision-making, supportive services, and communication were helpful, not helpful, or lacking. Methods: An anonymous survey about end-of-life experiences was sent to families of children treated at a single institution who died of a malignancy between 2010 and 2017. Results: Twenty-eight surveys were returned for a 30.8% response rate. Most of the bereaved parents (61%) reported a desire for shared decision-making; this was described by 52% of families at the end of their child’s life. There was a statistically significant association between how well death went and whether the parental perception of actual decision-making aligned with desired decision-making ( P = .002). Families did not utilize many of the supportive services that are available including psychology and psychiatry (only 22% used). Respondents felt that additional services would have been helpful. Conclusions: Health care providers should strive to participate in decision-making models that align with the preferences of the patient and family and provide excellent communication. Additional resources to support families following the death of a child should be identified for families or developed and funded if a gap in available services is identified.

Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals

2019 ◽  
Vol 18 (4) ◽  
pp. 425-430 ◽  
Author(s):  
Oindrila Dutta ◽  
Priya Lall ◽  
Paul Victor Patinadan ◽  
Josip Car ◽  
Chan Kee Low ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Patient Autonomy ◽  
Healthcare Professionals ◽  
Program Effectiveness ◽  
Self Determination ◽  
Truth Telling ◽  
Focus Group Study ◽  
Eol Care ◽  
Care Decision

AbstractObjectivesAsia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients’ autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.MethodsGuided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals’ attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.ResultsThe extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.Significance of resultsHealthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.

Mexican American Faculty in Research Universities: Can the Next Generation Beat the Odds?

2017 ◽  
Vol 3 (4) ◽  
pp. 458-473 ◽  
Author(s):  
Ruth Enid Zambrana ◽  
Brianne A. Dávila ◽  
Michelle M. Espino ◽  
Lisa M. Lapeyrouse ◽  
R. Burciaga Valdez ◽  
...  
Keyword(s):  
Social Capital ◽  
Research Universities ◽  
Mexican Americans ◽  
Mexican American ◽  
Maternal Education ◽  
Educational Aspirations ◽  
Implicit Bias ◽  
The United States ◽  
National Study ◽  
Underrepresented Minority

Mexican Americans represent the largest Latina/o subpopulation and have the lowest levels of educational attainment in the United States. Mexican Americans are underrepresented in all professional fields, including academia, and thus warrant attention. The purposes of this study are to describe the experiences of early and mid-career Mexican American faculty, emphasizing key sources of inspiration, support, and mentoring, perceived discrimination, and their coping responses; assess the ways in which these factors influence their careers; and examine differences by gender and maternal education. Mixed methods were used to obtain information from 133 Mexican American faculty who participated in a larger national study of underrepresented minority (URM) faculty at research universities. Five major findings emerged: (1) early life course support sustained and encouraged educational aspirations, (2) mentorship from significant others provided valuable advice in developing social capital throughout higher education and early faculty experiences, (3) female respondents were more likely to report inadequate mentoring and higher levels of distress due to recurrent experiences of racially gendered discrimination, (4) strategies of resistance reveal high levels of emotional labor as respondents deconstruct the hidden curriculum to perform effectively in environments that are imbued with implicit bias, and (5) maternal education contributed to improved mentoring experiences and active resistance strategies. The findings suggest that expanding social capital–driven strategies and increasing understanding of persistent anti-Mexican social policy that leads to misidentification and implicit bias are key in retention and professional success for Mexican American faculty.

End-of-Life Decision-Making

2017 ◽  
Author(s):  
Chad D. Kollas ◽  
Beth Boyer Kollas
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
End Of Life ◽  
Planning Process ◽  
Legal Reasoning ◽  
The United States ◽  
Medical Decision ◽  
The Right ◽  
End Of Life Decision ◽  
Life Decision

Growth in the size and wealth of the United States’ elderly population, coupled with a trend toward increasing patient autonomy, has created an environment for increased conflict in end-of-life decision-making. This chapter explores the required elements for making decisions at the end of life, including determination of medical decision-making capacity. Also discussed is the development of the legal reasoning that governs situations involving elderly patients who lack the capacity, but retain the right, to make medical decisions. The chapter describes the utility of the advance care planning process, by which elderly patients can make their preferences for medical treatment known in advance of conditions or illness that could result in cognitive impairment that would otherwise hamper their ability to participate personally in end-of-life decisions. Finally, a variety of forms of advance directives are described, critical tools in honoring the medical autonomy of elderly patients.

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