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

Abstract

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.

Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Ventilation When Hospitalized at the End-of-Life

“…Another explanation may be that the observed differences reflect the preferences and influence of family caregivers. While family is consistently endorsed as a key player in EOL decisionmaking among Asian Americans, [44][45][46][47][48][49] intergenerational differences in acculturation level complicate our understanding of familial roles at the EOL. 50 Future research into the mechanism by which Asian families make EOL decisions will enable the delivery of family-centered, goal-concordant, and culturally tailored EOL care.…”

Social determinants of willingness to discuss end‐of‐life care with family and doctors among Korean American immigrants: Findings from a cross‐sectional survey in Alabama

“…Previous studies adopted the SDH framework to examine the associations between social determinants and end-of-life outcomes, such as the use of hospice or palliative care, completion of advance directives or use of aggressive treatments (Brown et al, 2018;Koroukian et al, 2017;Rhee & Jang, 2020). Health literacy is one of the major SDH, and end-of-life specific health literacy-awareness or knowledge of hospice or palliative care-has been found to predict individuals'…”

Culture and Attitudes Towards Euthanasia: An Integrative Review

“…For example, in the US, autonomy is an empowering attribute while in Korea, it is burdensome (Blackhall et al, 1995) because Koreans prefer collective, family-based decision making over individualistic, patient-centered decision making (Newman et al, 2006). Acculturation to an individualistic culture may increase the need for autonomy among members of collectivistic cultures (Hamamura, 2012;Rhee & Jang, 2019); a study of seniors of multiple ethnicities living in New York indicated that they were uncomfortable delegating end-of-life decisions to family (Morrison et al, 1998). Collectivist cultures, on the other hand, impede individual decision making by removing the patient from euthanasia decisions (Blackhall et al, 1995), sometimes not even informing them about impending death (Schwartz, 2004).…”

“…This, in turn, affects candor; full disclosure of illness to patients is more likely in the US and European cultures vis-à-vis others (Ersek et al., 1998). The lack of candor is compounded by cultural beliefs against speaking about death (Rhee & Jang, 2019) held by Chinese and Mexicans, among others (Carrese & Rhoades, 1995).…”