Efficacy of a Church-Based, Culturally Tailored Program to Promote Completion of Advance Directives Among Asian Americans

Sun, Angela; Bui, Quynh; Tsoh, Janice Y.; Gildengorin, Ginny; Chan, Joanne; Cheng, Joyce; Lai, KY; McPhee, Stephen J.; Nguyen, Tung T.

doi:10.1007/s10903-016-0365-7

Cited by 40 publications

(57 citation statements)

References 43 publications

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“…The study also found that the odds of designating a SDM were higher for older adults who had stayed in the United States for 10 years or more, had English proficiency, and had a high level of acculturation into mainstream U.S. culture. These results supported our predictions and were consistent with previous studies (Dobbs et al., 2015; Jang et al., 2017; Sun et al., 2017). There is a great potential that older Asian Americans who have stayed in the United States longer, speak English fluently, and have higher level of acculturation may have adopted Western values and beliefs (i.e., patient autonomy and self-determination) and have applied these values to their EoL decision-making process.…”

Section: Discussionsupporting

confidence: 94%

Factors Associated With Designation of a Substitute Decision-Maker in Older Asian Americans: The Role of Cultural Factors

Rhee

Jang

2019

Int J Aging Hum Dev

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The present study examined the prevalence of and factors associated with the designation of a substitute decision-maker (SDM) in a sample of older Asian Americans. Particular emphasis was placed on cultural factors (ethnicity, time in the United States, English proficiency, acculturation, and cultural belief) that might influence on one’s attitudes toward death and dying or end-of-life decision-making. Data were drawn from the 499 participants aged 60 years and older using the 2015 Asian American Quality of Life survey. Twenty-two percent of the sample had completed a legal document identifying a SDM. Results of a hierarchical logistic regression indicated that ethnicity, time in the United States, English proficiency, and acculturation were significant predictors. By examining the role of cultural factors in predicting SDM designation, the present study provided implications for culturally tailored strategies to help older Asian Americans plan their end-of-life care.

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Section: Discussionsupporting

confidence: 94%

Factors Associated With Designation of a Substitute Decision-Maker in Older Asian Americans: The Role of Cultural Factors

Rhee

Jang

2019

Int J Aging Hum Dev

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“…ACP has been successfully promoted in faithbased community organizations for Black and Asian American populations, although these programs have not been widely implemented and may not reach entire communities. [47][48][49] Our results underscore the importance of community-based strategies tailored to the needs of unique neighborhoods-to reach all community-dwelling older adults living in underresourced or disadvantaged communities. 29 Given the complex etiology of health disparities and the sociocultural influences on end-of-life decision-making, 50 it is important to consider community-based factors contributing to ACP disparities.…”

Section: Discussionmentioning

confidence: 68%

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

et al. 2020

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IMPORTANCE Advance care planning (ACP) is low among older adults with socioeconomic disadvantage. There is a need for tailored community-based approaches to increase ACP, but community patterns of ACP are poorly understood. OBJECTIVETo examine the association between neighborhood socioeconomic status (nSES) and ACP and to identify communities with both low nSES and low rates of ACP. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study examined University of California San Francisco electronic health record (EHR) data and place-based data from 9 San Francisco Bay Area counties. Participants were primary care patients aged 65 years or older and living in the San Francisco Bay Area in July 2017. Statistical analysis was performed from May to June 2020. EXPOSURES Patients' home addresses were geocoded and assigned to US Census tracts. The primary factor, nSES, an index combining area-level measures of income, education, poverty, employment, occupation, and housing or rent values, was divided into quintiles scaled to the distribution of all US Census tracts in the Bay Area (Q1 = lowest nSES). Covariates were from the EHR and included health care use (primary care, outpatient specialty, emergency department, and inpatient encounters in the prior year). MAIN OUTCOMES AND MEASURESACP was defined as a scanned document (eg, advance directive), ACP Current Procedural Terminology code, or ACP note type in the EHR. RESULTS There were 13 104 patients included in the cohort-mean (SD) age was 75 (8) years, with 7622 female patients (58.2%), 897 patients (6.8%) identified as Black, 913 (7.0%) as Latinx, 3788 (28.9%) as Asian/Pacific Islander, and 748 (5.7%) as other minority race/ethnicity, and 2393 (18.3%) self-reported that they preferred to speak a non-English language. Of these, 3827 patients (29.2%) had documented ACP. The cohort was distributed across all 5 quintiles of nSES (Q1: 1426 patients

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“…Although we used the weights provided by data set to reduce sampling bias, the potential for a lack of representativeness is unavoidable. Also, potential direct contributors on ACP completion such as knowledge about the ACP (e.g., Sun, Bui, et al, 2016) or previous exposure to the EOL care (e.g., Jang et al, 2010) were not included in the analysis models due to the limitation of data. In addition, regarding EOL treatment, the data we used considered two specific conditions: experience of severe pain and loss of physical and/or cognitive function.…”

Section: Discussionmentioning

confidence: 99%

Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States

2019

Innovation in Aging

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Background and Objectives Advance care planning (ACP) is a critical component of health care affecting the quality of later life. Responding to the increase in the older immigrant population in the United States, this empirical study explored the racial/ethnic gaps in ACP behaviors among older immigrants and examined the end-of-life (EOL) care planning and preferences of foreign-born immigrant older adults focusing on race/ethnicity, acculturation, health need factors, and enabling social factors (financial capability, public assistance, and informal supports) after controlling predisposing factors (sociodemographic characteristics). Research Design and Methods Using a subsample from the National Health and Aging Trends Study 2011 and 2012, hierarchical logistic regression models of the EOL plan and preferences were examined with 50 multiple imputation data sets ( n = 232). Results Descriptive statistics reveal lower ACP engagement of immigrants from racial/ethnic minority groups. In logistic models, however, only Black immigrants were less likely than Whites to have EOL conversations. Among acculturation factors, age at immigration was only negatively associated with having a durable power of attorney for health, but not significantly associated with other ACP behaviors. Instead, health and social factors, primarily need in health and informal support (i.e., number of coresidents and receiving financial help from family members), were associated with different types of ACP components. Receiving public assistance (i.e., receiving Medicaid and SSI) were positively associated with EOL treatment preferences. Discussion and Implications Older foreign-born immigrants, in general, showed lower ACP engagement than the overall older population. Moreover, minority immigrants were lower on ACP engagement than both White immigrants. This study highlights the need for formal and informal assistance for enhancing EOL planning for older immigrants. Adding to the culturally competent approach, policy efforts should address social and health factors that accrued throughout individuals’ life spans and affect older immigrants’ EOL preparation and care.

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Efficacy of a Church-Based, Culturally Tailored Program to Promote Completion of Advance Directives Among Asian Americans

Cited by 40 publications

References 43 publications

Factors Associated With Designation of a Substitute Decision-Maker in Older Asian Americans: The Role of Cultural Factors

Factors Associated With Designation of a Substitute Decision-Maker in Older Asian Americans: The Role of Cultural Factors

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States

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