Beliefs in advance care planning among Chinese Americans: Similarities and differences between the younger and older generations

Abstract

The purpose of this research is to explore behavioral, normative, and control beliefs in the discussion of advance care planning (ACP) among older and younger Chinese Americans. Ethnic minority groups have been identified as less engaged in ACP and this represents an ethnic and cultural gap. Older Chinese American adults often have different beliefs and values compared to the younger generation who are more acculturated to American mainstream culture. These differences may hinder the discussion of ACP with Chinese older adults.A qualitative design was used. The Theory of Planned Behavior guided the development of the interview guide. We recruited 60 Chinese Americans. Prior experience was identified as a theme that influenced attitudes about ACP. We found that older and younger Chinese participants had different beliefs in the norm and control related to ACP discussions, but not in the belief of attitudes about ACP discussions. Both younger and older Chinese American participants believed that ACP was important and necessary. Participants in both clusters expressed that they were ready and willing to engage in ACP discussions with their family members but hesitant to initiate these discussions. The reluctance in discussing ACP with Chinese older adults may be related to the expectations and obligations of Xiao (filial piety) in Chinese culture. This study describes the similarities and differences of beliefs in ACP between older and younger Chinese Americans. We identified barriers and facilitators in behavioral, normative, and control beliefs that can be used to promote ACP for Chinese Americans.

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

“…This may be because the foreign-born Chinese Americans have lower socioeconomic status, less English proficiency, lower levels of acculturation, and less knowledge about ACP and the US healthcare system than their US-born counterparts. 11 , 12 , 22 In addition, these individual-level differences may be mixed with other system-level barriers within the US healthcare system to worsen the disparities in ACP engagement. 23 For example, Chinese American immigrants may have a stronger belief that family and society are held in higher regard than individuals, and attribute a higher value to collectivism of family and society rather than patient autonomy in EOL decision making.…”

“… 23 For example, Chinese American immigrants may have a stronger belief that family and society are held in higher regard than individuals, and attribute a higher value to collectivism of family and society rather than patient autonomy in EOL decision making. 12 Moreover, because traditional Chinese culture expects children to carry the role of protecting their parents' health, safety, and general well-being, many Chinese children may construe this responsibility as making every effort to prolong their older parents' life, which may sometimes be in opposition to their parents' own wishes. 24 These potential factors surrounding older Chinese immigrants may help explain this population's lack of engagement in ACP.…”

“…On the 1 hand, older Chinese Americans may have positive attitudes about ACP engagement and believe that ACP engagement is important and necessary because it allows them to witness their loved ones’ death and dying experience. 12 On the other hand, close-knit familial relationships may make both older Chinese Americans and their families feel more uncomfortable to start a conversation on EOL care because discussions about death and dying are often considered a taboo in Chinese culture. 30 In this sense, strong family ties may have limited impact on ACP engagement.…”

“…Compared with native-born Chinese Americans, foreign-born Chinese Americans may face more cultural and logistical challenges in ACP engagement because of their limited English proficiency, greater cultural burden in discussing death and dying and accepting individual autonomy, and lack of ACP knowledge. 11 , 12 In addition, the effectiveness of ACP may rely on the involvement, knowledge, and cooperation of family members 13 ; however, because of the lack of rich and comprehensive measures of family relationships in previous research on ACP, few studies have examined the extent to which family relationships influence individuals’ ACP engagement. To fill this knowledge gap, this study aimed to examine how immigrant status and family relationships are associated with ACP contemplation, ACP discussion with family, and preference in burial planning among older Chinese Americans.…”

Health-Assistive Smart Homes for Aging in Place: Leading the Way for Integration of the Asian Immigrant Minority Voice

“…Park and Lee (2017) found that sibling caregivers of older Korean adults had a sense of responsibility and obligation to take care of the brother or sister that was not explicit in studies with western participants. In another study with older and younger Chinese American adults, both groups perceived advanced care planning was important; however, both groups believed it was taboo to initiate discussion as it may bring bad luck to individuals and may hasten death (Lee, Byon, Hinderer, & Alexander, 2017). Thus, discussion of smart homes for older adults’ health care may disrupt culturally appropriate communication between Asian older adults and their children.…”