Please Ask Gently: Using Culturally Targeted Communication Strategies to Initiate End-of-Life Care Discussions With Older Chinese Americans

Background: Health-care providers (HCPs) find facilitating end-of-life (EOL) care discussions challenging, especially with patients whose ethnicities differ from their own. Currently, there is little guidance on how to initiate and facilitate such discussions with older Chinese Americans (≥55 years) and their families. Objective: To explore communication strategies for HCPs to initiate EOL care discussions with older Chinese Americans in the San Francisco Bay Area. Design: This qualitative (focused) ethnographic study included field observations and individual semistructured interviews with 14 community-dwelling older Chinese Americans who lived independently at home, 9 adult children, and 7 HCPs. Responses were analyzed using open coding, memos, and comparison across participants. Results: The study participants emphasized the importance of assessing readiness for early EOL care discussions. All recommended using indirect communication approaches to determine older Chinese Americans’ readiness. Indirect communication can be culturally targeted and applied at both system-wide (ie, health-care system) and individual (ie, HCP) levels. To institutionalize the practice, health-care facilities should implement EOL care discussion inquiries as part of routine during check-in or intake questionnaires. In individual practice, using depersonalized communication strategies to initiate the discussion was recommended to determine older Chinese Americans’ readiness. Conclusion: Assessing readiness should be an essential and necessary action for early EOL care discussions. Culturally targeted assessment of older Chinese Americans includes using indirect communication approaches to initiate an EOL care discussion to determine their readiness. In addition to health-care system integration, providers should implement and evaluate proposed EOL discussion initiation prompts with their older Chinese American patients.

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Family Conflict and Older Chinese Americans’ Self-Efficacy in End-of-Life Care Planning: The Role of Acculturation

Innovation in Aging ◽

10.1093/geroni/igab046.2183 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 572-572

Author(s):

Kaipeng Wang ◽

Fei Sun ◽

Yanqin Liu ◽

Carson de Fries

Keyword(s):

Older Adults ◽

End Of Life ◽

Family Conflict ◽

Self Efficacy ◽

Family Members ◽

Chinese Americans ◽

Care Planning ◽

Older Chinese ◽

Eol Care ◽

Older Chinese Americans

Abstract Family involvement in end-of-life (EOL) care is critical to ensure older adults’ health and quality of life. Older adults’ self-efficacy in discussing EOL care plans with family members can facilitate family involvement in EOL care planning. Research shows that family relationships are associated with self-efficacy in discussing EOL care with family members among older Chinese Americans. However, the roles of family conflict and acculturation remain unknown. This study examines the association between family conflict and self-efficacy in discussing EOL care with family members and whether such an association differs by acculturation levels among older Chinese Americans. Data were collected from 207 Chinese Americans aged 65-102 in two metropolitan areas in 2017. Ordinary least squares regression was conducted to examine the association between family conflict, acculturation, and self-efficacy in discussing EOL care with family. Family conflict was negatively associated with older adults’ self-efficacy in discussing EOL care with family. More specifically, the negative association between family conflict and self-efficacy in discussing EOL care with family members was more pronounced for those with higher levels of acculturation. Findings highlighted differential effects of family conflict on self-efficacy of EOL care plan discussion for older adults with different acculturation levels. Those with higher acculturation may be more independent in their EOL care planning and aware of the possible negative effects of family conflict in their EOL care planning discussions. Acculturation needs to be considered by geriatric health providers to develop family-centered interventions in improving end-of-life care planning for this population.

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Attitude Toward Family Involvement in End-of-Life Care Among Older Chinese Americans: How Do Family Relationships Matter?

Journal of Applied Gerontology ◽

10.1177/0733464821996865 ◽

2021 ◽

pp. 073346482199686

Author(s):

Kaipeng Wang ◽

Fei Sun ◽

Yanqin Liu ◽

Dexia Kong ◽

Carson M. De Fries

Keyword(s):

End Of Life ◽

Family Involvement ◽

Family Relationships ◽

Indirect Effects ◽

Chinese Americans ◽

Equation Modeling ◽

Care Plans ◽

Older Chinese ◽

Eol Care ◽

Older Chinese Americans

Family involvement is critical to end-of-life (EOL) care among older adults. This study aims to examine the association and pathways between family relationships and older Chinese Americans’ attitude toward family involvement in EOL care discussions. Data were collected from 260 Chinese Americans aged 55 years and above. Structural equation modeling was used to examine the total and indirect effects of family relationships on attitude toward family involvement in discussing EOL care plans. Family relationships had a significant positive total effect on attitude toward family involvement in EOL care. Indirect effects of family relationships on attitude toward family involvement in EOL care through self-efficacy, perceived benefits, and perceived barriers of discussing EOL care with family members were all significant. Findings provide empirical evidence of how family relationships affect older Chinese Americans’ attitude toward family involvement in EOL care and underline the need for family-centered EOL interventions for this population.

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Advance Care Planning Engagement and End-of-Life Preference Among Older Chinese Americans

Innovation in Aging ◽

10.1093/geroni/igaa057.2704 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 750-751

Author(s):

Yaolin Pei ◽

Wei Zhang ◽

Bei Wu

Keyword(s):

End Of Life ◽

Family Relationships ◽

Family Cohesion ◽

Chinese Americans ◽

Care Planning ◽

Foreign Born ◽

Advance Care ◽

Older Chinese ◽

Eol Care ◽

Older Chinese Americans

Abstract The study aimed to examine how immigrant status and family relationships are associated with advanced care planning (ACP) engagement and end-of-life (EOL) preference over burial plan among older Chinese Americans, the largest subgroup of Asian Americans. Logistic regressions were used to analyze data from a survey of 430 older Chinese Americans aged 55 and older living in a Honolulu, Hawai’i. Results show that U.S.-born Chinese Americans were more likely to engage in ACP, including willingness thought of EOL care, and discussion about EOL care, and having preference over burial plan, than the foreign-born Chinese American. Family cohesion was not associated with ACP engagement and EOL preference over burial plan. Family conflict increased the possibility of ACP engagement, indicated by willingness thought of ACP, willingness discussion on ACP, and EOL preference over burial plan. The culturally sensitive educational intervention is needed to increase ACP engagement among older Chinese Americans.

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Preferences and Determinants of End-of-Life Care Among Older Chinese Americans

Innovation in Aging ◽

10.1093/geroni/igab046.1378 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 357-357

Author(s):

Dexia Kong ◽

Elissa Kozlov ◽

XinQi Dong

Keyword(s):

End Of Life ◽

Chronic Conditions ◽

Chinese Americans ◽

Female Gender ◽

Population Based ◽

Health Determinants ◽

Minority Population ◽

Older Chinese ◽

Eol Care ◽

Older Chinese Americans

Abstract End-of-life (EOL) care awareness and practice remain particularly low among older Chinese Americans. More empirical evidence regarding EOL is needed to develop culturally-relevant interventions to promote EOL engagement in this minority population. Using population-specific data, this study investigates preferences and associated sociodemographic and health determinants related to EOL among older Chinese Americans. Data were from the Population-based Study of Chinese Elderly in Chicago (collected 2017-2019, N=3,124). Linear and logistic regressions were conducted. Of the sample, 46.1% considered EOL care planning as important or somewhat import. Nearly 22% had EOL discussions with families. The most preferred EOL locations were home (43.7%), hospital (35.5%), nursing home (10.1%), and hospice (4.3%). Overall, 47.1% perceived EOL care as family decisions, 39.6% regarded EOL care as personal decisions, 7.5% preferred children to make EOL decisions, and 3.3% preferred a spouse to make EOL decisions. Chinese older adults who were female (B=0.10, p<0.01), married (B=0.11, p<0.01), had higher education (B=0.02, p<0.001), acculturation level (B=0.02, p<0.001), and religiosity (B=0.12, p<0.001), and more chronic conditions (B=0.05, p<0.001) were more likely to consider EOL as important. Those with older age [Odds Ratio (OR)=1.02, 95% Confidence Interval (CI)=1.01-1.03], female gender (OR=1.44, 95% CI=1.18-1.77), higher levels of education (OR=1.02, 95% CI=1.01-1.04), acculturation (OR=1.04, 95% CI=1.01-1.06), and religiosity (OR=1.11, 95% CI=1.02-1.21), longer U.S. residence (OR=1.02, 95% CI=1.01-1.03), and more chronic conditions (OR=1.13, 95% CI=1.06-1.21) were more likely to have discussed EOL preferences with their families. Study findings underscore low engagement in EOL planning in this population and the need for culturally-appropriate interventions.

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Attitude Toward Family Involvement in End-of-Life Care Among Older Chinese Americans

Innovation in Aging ◽

10.1093/geroni/igaa057.1638 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 507-507

Author(s):

Kaipeng Wang ◽

Yanqin Liu ◽

Fei Sun ◽

Dexia Kong ◽

Bei Wu

Keyword(s):

Family Involvement ◽

Self Efficacy ◽

Positive Attitude ◽

Family Relationship ◽

Family Members ◽

Chinese Americans ◽

Perceived Barriers ◽

Older Chinese ◽

Eol Care ◽

Older Chinese Americans

Abstract Family involvement is critical to end-of-life (EOL) care of older adults. Attitude toward family involvement in EOL care can be influenced by family relationship. Yet, mechanisms explaining such influence have not been examined among older Chinese Americans. This study aims to examine the association between family relationship and older Chinese Americans’ attitude toward family involvement in EOL care and explore pathways of this association. Potential mediators include self-efficacy, perceived benefits, and perceived barriers of discussing EOL care with family members. Data were collected from 276 Chinese Americans aged 55+ in two metropolitan areas in 2018. Participants’ average age was 74 years (SD=9.6). Approximately 64% of the sample were female. Most participants (57%) held positive attitudes toward family involvement in EOL care. Using the Structural Equation Modeling method, we found that family relationship had a significant positive total effect on positive attitude toward family involvement in EOL care (z=5.57, p<0.001). Indirect direct of family relationship on attitude toward family involvement in EOL care through both self-efficacy (z=3.13, p<0.01) and perceived barriers (z=2.30, p<0.05) of discussing EOL care with family members was significant. Results suggest that improving family relationship may increase elder’s self-efficacy and reduce barriers of discussing EOL with family members, which is associated with more positive attitude toward family involvement in EOL care. Findings provide empirical evidence of how family relationship affects older Chinese Americans’ attitude toward family involvement in EOL care and underline the need for family-centered interventions for older Chinese Americans.

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Palliative Care as Response to Suffering at End of Life

Review of Ecumenical Studies Sibiu ◽

10.2478/ress-2014-0118 ◽

2014 ◽

Vol 6 (2) ◽

pp. 227-245

Author(s):

Daniela Moşoiu

Keyword(s):

Health Care ◽

Palliative Care ◽

End Of Life ◽

Health Care System ◽

Spiritual Distress ◽

History Of Development ◽

History Of ◽

Hospice And Palliative Care ◽

Care System

Abstract Persons suffering from chronic and life limiting illnesses often have unrelieved symptoms such as pain, depression, fatigue, and psychosocial and spiritual distress. In Romania they are frequently left in the care of their families with little support from the health care system. It seems a paradox that those who are the sickest persons in a country find little place in the health care system. This article presents palliative care as a solution to the suffering for these patients and their families by describing the concept, models of services, its beneficiaries and benefits and presenting the history of development of hospice and palliative care worldwide and in Romania.

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