Attitudes and Beliefs Toward Advance Care Planning Among Underserved Chinese-American Immigrants

Dhingra, Lara; Cheung, William; Breuer, Brenda; Huang, Peiwu; Lam, Kin; Chen, Jack; Zhou, Xiaotian; Chang, Victor; Chui, Timothy; Hicks, Stephanie; Portenoy, Russell K.

doi:10.1016/j.jpainsymman.2020.04.013

Cited by 19 publications

(34 citation statements)

References 28 publications

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“…The authors developed the first draft of this questionnaire after reviewing the literature [12][13][14][15]. The developed questionnaire inquires into demographic characteristics and knowledge, attitudes, behavior intentions, subjective norms, and influencing factors regarding ACP (see S1 File).…”

Section: Measurementsmentioning

confidence: 99%

Knowledge, attitudes, and behavioral intentions of elderly individuals regarding advance care planning: Questionnaire development and testing

Cheng

Chang

et al. 2022

PLoS ONE

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Background Studies have indicated that the advance care planning knowledge and attitudes of elderly individuals strongly affect their implementation of advance care planning. A measurement with a theoretical base for evaluating elderly individuals’ knowledge, attitudes, and behavioral intentions regarding advance care planning is lacking. Objectives To develop a questionnaire and understand elderly individuals’ knowledge, attitudes, and behavioral intentions regarding implementing advance care planning. Methods A cross-sectional questionnaire survey was conducted. The content validity index, and statistical methods, including discrimination, factor, and reliability analysis, were adopted for psychometric testing. Descriptive statistics mainly presented data analysis. Results 401 elderly individuals were recruited from a medical center and one senior activity center. The content validity index was approximately 0.71–0.92 for the developed questionnaires, the Kuder–Richardson formula 20 was 0.84 for advance care planning knowledge, and the Cronbach’s alpha was 0.86, 0.94, 0.76, and 0.92 for attitudes, behavioral intentions, influencing factors, and subjective norms, respectively. The average score for advance care planning knowledge for elderly individuals was 4.42, with a correct answer rate of 49.1%. They lacked knowledge of advance care planning-related legislation. The mean score for attitudes and behavioral intentions was 14.32 and 3.48, respectively. Elderly individuals agreed that advance care planning has benefits but were worried about the emotional distress caused by advance care planning discussions. Elderly individuals with positive behavioral intentions tend to implement advance care planning. Spouses, children, doctors, and nurses are significant reference people for elderly individuals. Conclusions The developed questionnaire exhibits good validity and reliability for understanding elderly individuals’ knowledge, attitudes, and behavioral intentions concerning advance care planning. Advance care planning materials or decision aids suitable for elderly individuals must be developed to increase their understanding of advance care planning. Additionally, the role of nurses is indispensable in promoting advance care planning among elderly individuals.

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Section: Measurementsmentioning

confidence: 99%

Knowledge, attitudes, and behavioral intentions of elderly individuals regarding advance care planning: Questionnaire development and testing

Cheng

Chang

et al. 2022

PLoS ONE

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“…Possible explanations for the positive receptivity may be that Chinese Americans prefer an authority guided, informal, and indirect approach to ACP. 19,[40][41][42][43][44][45][46] Beyond attendance, a majority of participants also documented their top EOL priorities and intent to complete an AHCD. 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.…”

Section: Hth Cafés' Role In Promoting Acp Engagement and Educationmentioning

confidence: 99%

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

Jia

Stokes

Pan

et al. 2021

Am J Hosp Palliat Care

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Context: A paucity of literature describes the growing Chinese American community’s end-of-life (EOL) priorities and preferences. Objective: Develop a culturally-tailored advance care planning (ACP) tool to understand the EOL preferences of this underserved minority group. Methods: Informed by the Cultural Appropriateness Theory, the Chinese American Coalition for Compassionate Care (CACCC) developed Heart to Heart (HTH) Cards using a 3-step approach. First, CACCC created and refined a list of bilingual, culturally relevant EOL issues. Next, CACCC organized the EOL issues into a card deck. Finally, CACCC developed a unique playstyle of the cards—the HTH Café. From 2014-2019, CACCC recruited Chinese American volunteers and participants for HTH Cafés. Following each Café, participants completed an anonymous survey describing their sociodemographics, top 3 cards, and café evaluation. Results: The 54 HTH Cards were organized into 4 suits (spiritual, physical, financial/legal, and social). Each card displayed a culturally-tailored EOL issue in English and Chinese. Playstyles included one-on-one and group formats (ie. HTH Café). CACCC volunteers conducted 316 HTH Cafés for 2,267 Chinese American adults. Most participants were female (61.6%), between 18-50 years old (56.7%), lived in California (80.2%) and born in Asia (74.3%). The top priority (25.5%) was “If I’m going to die anyway, I don’t want to be kept alive by machines.” Participants thought the session was pleasant (99.5%) and expressed intent to complete advance directives (86.5%). Conclusion: HTH Cards represents the first, theory-driven, culturally-tailored ACP tool for Chinese Americans. More research is needed to establish its impact on ACP conversations and outcomes.

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“…14 A recent Chinese-American study where most respondents had chronic health conditions, found that over 3 quarters preferred not to discuss resuscitation preferences. 15 These were in part related to culturally entrenched health beliefs, where almost one-third believed that involving a dying person in discussions relating to death could hasten death, and 13% who felt that discussing death brought bad luck. 15 In Australia, China is the 2nd most common migrant country of birth after England.…”

Section: Introductionmentioning

confidence: 99%

“…15 These were in part related to culturally entrenched health beliefs, where almost one-third believed that involving a dying person in discussions relating to death could hasten death, and 13% who felt that discussing death brought bad luck. 15 In Australia, China is the 2nd most common migrant country of birth after England. 16 ACP and end-of-life issues are strongly determined by socio-cultural factors, among others.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Large Scale Advance Care Planning Co-Design Education Program for Chinese-Speaking People in Australia

Wong

Collins

et al. 2021

Am J Hosp Palliat Care

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Background: Advance care planning (ACP) is important, however ethnic minorities have half the completion rates in the United States compared to Caucasian counterparts, and in Australia only 3.5% of advance directives were completed by those overseas-born.Educational intervention improves ACP knowledge and subsequent uptake. We evaluated immediate and longer-term outcomes of a co-designed ACP education toolkit in Chinese-speaking people in Victoria, Australia. Methods: We conducted a cross-sectional survey of Chinese-speaking community members who participated in a co-designed Chinese ACP educational workshop. A self-selected subgroup were subsequently contacted 6 months later to determine longer-term outcomes. Results: Of 519 attendees across 17 workshops, 325 (63%) completed the evaluation. The majority (63%;n = 206) were previously unaware of ACP. Perception of receipt of useful information positively correlated with motivation to undertake ACP ( r = 0.3486, p < 0.001). Of the 70 participants who consented to follow up, 36% (n = 26) agreed to participate in structured telephone interviews. English speakers were more likely to have undertaken ACP (n = 6 vs n = 3). ACP completion was not associated with being a carer or suffering from cancer or chronic illness. Conclusions: This first Australian study evaluating ACP co-design education implementation outcomes in Chinese-speaking people supports that motivation to undertake ACP is related to knowledge, albeit a modest ACP uptake in a small follow up sample. Clinicians should note that this assists with ACP uptake, with likely downstream improved health outcomes. This co-designed toolkit could be helpful in increasing ACP uptake. Future engagement by Chinese language societies to overcome further barriers to ACP is needed.

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Attitudes and Beliefs Toward Advance Care Planning Among Underserved Chinese-American Immigrants

Cited by 19 publications

References 28 publications

Knowledge, attitudes, and behavioral intentions of elderly individuals regarding advance care planning: Questionnaire development and testing

Knowledge, attitudes, and behavioral intentions of elderly individuals regarding advance care planning: Questionnaire development and testing

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

Evaluation of a Large Scale Advance Care Planning Co-Design Education Program for Chinese-Speaking People in Australia

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