Chinese Americans' attitudes toward advance directives: An assessment of outcomes based on a nursing-led intervention

Hinderer, Katherine A.; Lee, Mei Ching

doi:10.1016/j.apnr.2019.04.003

Cited by 26 publications

(62 citation statements)

References 23 publications

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“… 27 The inconsistency is likely due to the fact that Chinese Americans value family in the process of EOL decision making. 28 , 29 The lack of association between family cohesion and ACP engagement may be because older adults with higher levels of family cohesion have to balance between the potential benefit and harm of ACP engagement. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Pei

Zhang

2021

Journal of the American Medical Directors Association

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Objectives To examine how immigrant status and family relationships are associated with advance care planning (ACP) engagement and end-of-life (EOL) preference in burial planning among older Chinese Americans, the largest subgroup of Asian Americans. Design Cross-sectional survey. Setting Communities in Honolulu, Hawai'i. Participants Participants were 430 older Chinese Americans aged 55 years and older. Measures Measures included ACP contemplation, ACP discussion, and EOL preference in burial planning, immigrant status, family cohesion, family conflict, demographic information, and health status. Results Results show that in comparison to foreign-born Chinese Americans, US-born Chinese Americans were more likely to have ACP contemplation [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.39-5.63], ACP discussion (OR 3.02, 95% CI 1.50-6.08), and preferences for burial plans at the end of life (OR 4.56, 95% CI 2.04-10.18). Family conflict increased the possibility of having ACP contemplation (OR 1.21, 95% CI 1.07-1.38), ACP discussion (OR 1.22, 95% CI 1.07-1.39), and EOL preference in burial planning (OR 1.22, 95% CI 1.04-1.42), whereas family cohesion was not associated with these study outcomes. Conclusions and Implications This study suggests that ACP should be adapted to be more culturally appropriate, especially in a time of coronavirus and xenophobia, such as framing ACP as a tool to help families reduce stress while fulfilling filial obligations, in order to ensure equitable access to ACP.

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Section: Discussionmentioning

confidence: 99%

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

Pei

Zhang

2021

Journal of the American Medical Directors Association

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Section: Discussionmentioning

confidence: 99%

“…In contrast, the persons with dementia may have been less able to discuss their concerns due to age-and disease-related factors. Other studies have shown persons with dementia are less interested in abstract problems unrelated to urgent needs [42][43][44]. There are several explanations for the lack of significant differences in positive attitudes following the intervention for both the persons with dementia and FCGs.…”

Section: Effects Of the Intervention On Attitude Toward Advance Care mentioning

confidence: 96%

Advance care planning information intervention for persons with mild dementia and their family caregivers: Impact on end-of-life care decision conflicts

Huang

Liu

et al. 2020

PLoS ONE

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Persons with dementia are at high risk for loss of decision-making ability due to increased cognitive decline as the disease progresses. Participation in advance care planning (ACP) discussions in the early stages of dementia is crucial for end-of-life (EoL) decision-making to ensure quality of EoL care. A lack of discussions about ACP and EoL care between persons with dementia and family caregivers (FCGs), can lead to decisional conflicts when persons with dementia are in the later stages of the disease. This study explored the effects of a family-centered ACP information intervention among persons with dementia and FCGs. The study was conducted in outpatient clinics in Taiwan. Participants were dyads (n = 40) consisting of persons diagnosed with mild cognitive impairment or mild dementia and their FCGs. A one-group, pretest-posttest, pre-experimental design was employed. The intervention was provided by an ACP-trained senior registered nurse and was guided by ACP manuals and family-centered strategies. Outcome data were collected with four structured questionnaires regarding knowledge of end-stage dementia treatment, knowledge of ACP, attitude towards ACP, and EoL decisional conflict about acceptance or refusal of cardiopulmonary resuscitation, ventilators, and tracheostomy. Paired t tests compared differences between pre-intervention data and 4-weeks' post-intervention data. The intervention resulted in significant improvements among persons with dementia and FCGs for knowledge of end-stage dementia treatment (p = .008 and p < .001, respectively), knowledge of ACP (both p < .001), and significant reductions in decisional conflicts (both p < .001). Scores for positive and negative attitude toward ACP did not change for persons with dementia; however, there was a reduction in negative attitude for FCGs (p = .001). Clinical care for persons with dementia should incorporate ACP interventions that provide knowledge about EoL dementia care using family-centered care strategies that facilitate regular and continuous communication between FCGs, persons with dementia, and medical personnel to reduce decisional conflicts for EoL care.

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“…Table 1 presents detailed study characteristics for the included articles. Of note, two articles reported diff erent outcome measures from the same intervention (Hinderer & Lee, 2019;Lee et al, 2015). Th ree articles included interventions developed for Asian American individuals (Hinderer & Lee, 2019;Lee et al, 2015;Sun et al, 2017) and two were developed for Hispanic individuals (Heyman & Gutheil, 2010;Nedjat-Haiem et al, 2019).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Of note, two articles reported diff erent outcome measures from the same intervention (Hinderer & Lee, 2019;Lee et al, 2015). Th ree articles included interventions developed for Asian American individuals (Hinderer & Lee, 2019;Lee et al, 2015;Sun et al, 2017) and two were developed for Hispanic individuals (Heyman & Gutheil, 2010;Nedjat-Haiem et al, 2019). In three articles, 99% or all participants were foreign-born (Hinderer & Lee, 2019;Lee et al, 2015;Sun et al, 2017), and another article reported the majority (61%) of study participants were foreignborn (Nedjat-Haiem et al, 2019).…”

Section: Study Characteristicsmentioning

confidence: 99%

Community-Based Advance Care Planning Interventions for Minority Older Adults: A Systematic Review

Estrada¹,

Cohen²,

Shang³

2021

J Gerontol Nurs

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Racial/ethnic minority older adults in the United States often experience access, language, and cultural barriers to advance care planning. For the current study, a systematic review was conducted to summarize and appraise the current science on community-based interventions aimed at increasing advance care planning in racial/ethnic minority older adults. Five articles met the inclusion criteria, which represented four unique interventions in Asian American (n = 2) and Hispanic (n = 2) communities. Two interventions were nurse-led workshops and two were one-onone social worker-led sessions. Outcomes measured were intention to or completion of advance directive or advance care planning discussion; and improvement in advance directive knowledge, beliefs, attitudes, and comfort related to advance care planning. Interventions increased intention to or completion of advance directives and improved advance care planning knowledge, beliefs, and attitudes. Results were inconclusive regarding promoting advance care planning discussions. Further research is needed to address the diverse needs of racial/ethnic minority older adults and barriers to advance care planning.

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Chinese Americans' attitudes toward advance directives: An assessment of outcomes based on a nursing-led intervention

Cited by 26 publications

References 23 publications

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

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

Advance care planning information intervention for persons with mild dementia and their family caregivers: Impact on end-of-life care decision conflicts

Community-Based Advance Care Planning Interventions for Minority Older Adults: A Systematic Review

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