Advance Care Planning Among Chinese Americans Through a Web-Based Culturally Tailored Education Program

Abstract

At any time, a medical crisis could result in an individual too sick to make one's own health care decisions. Advance care planning (ACP) is an important step to ensure that each person receives the medical care desired. Despite its significant importance and proven benefits, the completion rate for advance directive is approximately one-third among the general population in the United States and lower among Chinese Americans. This study explored Chinese Americans' knowledge and attitudes about ACP following completion of a web-based culturally tailored health education program. Ninety-six individuals completed the study between October 1 and December 31, 2020. Prestudy-poststudy outcomes measured included the Advance Directive Knowledge Survey and Advance Directive Attitude Scale administered before and after completion of the education program. Each measure has 9 questions and 16 questions, respectively. Participants' Advance Directive Knowledge Survey scores (pre: mean, 6.04 [SD, 2.28]; post: mean, 8.75 [SD, 0.53]; P < .01) and Advance Directive Attitude Scale scores (pre: mean, 47.31 [SD, 5.69]; post: mean, 53.59 [SD, 4.37]; P < .01) increased significantly following program completion. Findings indicated feasibility for integration of web-based technology and culturally tailored approaches to promote ACP knowledge and attitudes among Chinese Americans.

Chinese Diaspora Communities’ Knowledge of and Engagement with Advance Care Planning: A Systematic Integrative Review

“…A total of 27 studies comprised twelve qualitative studies, 18 , 27 - 37 fourteen quantitative 38 - 51 and one mixed-method study. 52 Qualitative research design used a combination of in-depth interviews, 18 , 28 , 29 , 32 - 35 , 37 focus groups, 18 , 27 , 30 , 31 , 36 and informal field observation.…”

“…While studies were internationally spread they mainly represented the United States (n = 18), 27 , 30 , 31 , 33 , 34 , 37 , 38 , 40 - 44 , 47 - 52 followed by Singapore (n = 4), 18 , 29 , 39 , 46 Australia (n = 2), 32 , 45 Canada (n = 1), 28 Malaysia (n = 1) 35 and cross-country included Taiwan, Hong Kong, Singapore, and Australia (n = 1). 36 No studies were undertaken in the UK.…”

“…34 Quantitative studies adopted cross-sectional, [38][39][40][41][42][43][44] longitudinal 45 and non-randomized experimental designs. [46][47][48][49][50][51] The mixed-method research design included both survey and in-depth interviews. 52 Study characteristics and summary are provided in table 3.…”

“…Two different but overlapping main themes were identified which reflect Chinese diaspora engagement with advance care planning; namely, awareness and knowledge were identified in 10 studies, 18,[30][31][32]39,41,45,47,50,51 and engagement with advance care planning in 20 studies. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][44][45][46][47]49,52 Theme 1: Awareness and Knowledge Ten studies 18,[30][31][32]39,41,45,47,50,51 reported on the levels of awareness and knowledge regarding advance care planning among Chinese diasporas. Combined findings indicate levels of advance care planning ranged from low 18,[30][31][32]39,41,45,…”

“…Combined findings indicate levels of advance care planning ranged from low 18,[30][31][32]39,41,45,50 to moderate. 47,51 However, levels were influenced by a range of demographic and socio-cultural factors. For example, sociodemographic attributes such as education level, acculturation stage, language barrier, and age group were identified as key influencing variables.…”