Advance Care Planning Engagement and End-of-life Preference Among Older Chinese Americans: Do Family Relationships and Immigrant Status Matter?

Abstract

Objectives To examine how immigrant status and family relationships are associated with advance care planning (ACP) engagement and end-of-life (EOL) preference in burial planning among older Chinese Americans, the largest subgroup of Asian Americans. Design Cross-sectional survey. Setting Communities in Honolulu, Hawai'i. Participants Participants were 430 older Chinese Americans aged 55 years and older. Measures Measures included ACP contemplation, ACP discussion, and EOL preference in burial planning, immigrant status, family cohesion, family conflict, demographic information, and health status. Results Results show that in comparison to foreign-born Chinese Americans, US-born Chinese Americans were more likely to have ACP contemplation [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.39-5.63], ACP discussion (OR 3.02, 95% CI 1.50-6.08), and preferences for burial plans at the end of life (OR 4.56, 95% CI 2.04-10.18). Family conflict increased the possibility of having ACP contemplation (OR 1.21, 95% CI 1.07-1.38), ACP discussion (OR 1.22, 95% CI 1.07-1.39), and EOL preference in burial planning (OR 1.22, 95% CI 1.04-1.42), whereas family cohesion was not associated with these study outcomes. Conclusions and Implications This study suggests that ACP should be adapted to be more culturally appropriate, especially in a time of coronavirus and xenophobia, such as framing ACP as a tool to help families reduce stress while fulfilling filial obligations, in order to ensure equitable access to ACP.

Predictors of Advance Care Planning Engagement Among Muslim Americans

“…This finding is similar to the findings in a study of ACP in Chinese immigrants, where researchers found that United States-born Chinese Americans were more likely to engage in ACP than those who were born outside the United States. 25 One explanation for this finding is that those who were born in the United States (nonimmigrants) might be more knowledgeable and aware of ACP than those who were not born in the United States (immigrants). In a study of ACP in Russian immigrants, researchers found that first-generation Russian American immigrants had lower awareness and knowledge about ACP than nonimmigrant Russian Americans.…”

Advance care planning readiness for Chinese older people: An integrative review and conceptual framework

“…A study explored the factors that influence advance care planning engagement among Chinese Americans aged ≥55 years in Hawaii and found that family relationships affect advance care planning in a complex association, and that cultural factors play an essential role in advance care planning. 22 The results of a qualitative study in 28 older adults in Taiwan reported that advance care planning could help reach a death without suffering. Family relationships and family members' readiness were essential roles in advance care planning engagement.…”

Heart to Heart Cards: A Novel, Culturally Tailored, Community-Based Advance Care Planning Tool for Chinese Americans

“…may assist in clarifying goals and expectations surrounding food intake at the EOL. Third, Chinese Americans' low awareness and knowledge of ACP 35,36 led CACCC to incorporate ACP-specific items (e.g. advance directives, life sustaining treatment, and disease progression) as prompts for further education and discussion.…”

“…These preliminary results highlight HTH Café's potential for promoting ACP engagement among Chinese Americans, especially when compared with prior literature demonstrating low completion of advance directives and ACP contemplation. 35,36 A unique element of the HTH Café that may have facilitated the high levels of engagement is its group-based format. Existing literature demonstrates that group visits may improve self-efficacy in ACP through high-quality education, and facilitator and peer-supported discussions.…”