Knowledge of advance directive and perceptions of end-of-life care in Chinese-American elders: The role of acculturation

Abstract

Acculturation levels influence awareness of an AD, and family values are crucial in EoL care decision making. Cultural factors should be considered in designing and delivering appropriate programs to promote knowledge of EoL care among Chinese-American elders and their families.

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

“…The receptivity to ACP discussions in the OG was somewhat surprising. A study suggested that older, less acculturated minorities do not see the benefit in ACP (Gao, Sun, Ko, Kwak, & Shen, 2015;Kwak & Haley, 2005;Matsumura et al, 2002). The finding that older participants had a positive attitude about ACP in this study was encouraging: despite the traditional cultural beliefs about death and dying, introducing and promoting the ACP in Chinese Americans could be feasible and practical.…”

Exploring the knowledge, attitudes and needs of advance care planning in older Chinese Australians

“…This signals that the changing values and increased education level amongst Chinese people may override the relevancy of cultural taboo, hence allowing them to be more open about discussing sensitive topics pertaining to death. Acculturation is often brought up as an enabler of ACP in studies looking at the older migrant populations living in Western countries (Gao et al., ). However, this does not appear to be the case in this study as 30% of our participants had been in Australia for <5 years.…”

“…In this study, we found that there was a sense of regard for authorities amongst our participants. Respect for authority figures, including doctors, may be a reflection of Confucian's teachings that permeate Chinese culture (Chu & Woo, ; Gao et al., ; Ng, Chan, Ng, Chiam, & Lim, ; Wong et al., ). Using these authority figures to engage key support networks including family members and Chinese community groups was recognised as essential for ACP promotion as these support networks are important to bridge the gap between these older Chinese Australians and the health system.…”

“…Chinese communities around the world have a low engagement with ACP services (Con, 2007; Cultural & Indigenous Research Centre Australia (CIRCA), 2008, Gao, Sun, Ko, Kwak, & Shen, 2015;Ni et al, 2014;Ting & Mok, 2011;Yonashiro-Cho et al, 2016). The reasons for this are generally attributed to cultural considerations including taboos related to end-of-life consideration and the role of the collective family in decision-making or logistical considerations including health literacy, language and access to health services.…”

“…However, it was also mentioned that children of the terminally ill might sometimes withhold a diagnosis from their parent to help reduce his or her mental burden. Such an act is an expression of filial piety, another value emphasised in Confucianism (Fan & Li, 2004 (Chu & Woo, 2004;Gao et al, 2015;Ng, Chan, Ng, Chiam, & Lim, 2013;Wong et al, 2012). Using these authority figures to engage key support networks including family members and Chinese community groups was recognised as essential for ACP promotion as these support networks are important to bridge the gap between these older Chinese Australians and…”