Exploratory Study of Advance Care Discussions Among Chinese American and White Stage IV Cancer Patients at an American Tertiary Medical Center

Abstract

Purpose: Timely advance care discussions are essential components of quality care for diverse populations; however, little is known about these conversations among Chinese American cancer patients. This exploratory study describes differences in advance care discussions and planning between Chinese American and White advanced cancer patients. Methods: We collected data for 63 Chinese American and 63 White stage IV cancer patients who died between 2013 and 2018. We compared: frequency and timing of prognosis, goals of care (GOC), and end-of-life care (EOLC) discussions in the final year of life; family inclusion in discussions; healthcare proxy (HCP) identification; do not resuscitate (DNR) order, do not intubate (DNI) order, and other advance directive (AD) completion. We did not conduct statistical tests due to the study’s exploratory nature. Results: Among Chinese American and White patients, respectively, 76% and 71% had prognosis, 51% and 56% had GOC, and 89% and 84% had EOLC discussions. Prognosis, GOC, and EOLC discussions were held a median of 34.0, 15.5, and 34.0 days before death among Chinese American and 17.0, 13.0, and 24.0 days before death among White patients. Documentation rates among Chinese American and White patients were 79% and 76% for DNRs, 81% and 71% for DNIs, 79% and 81% for HCPs, and 52% and 40% for other ADs. Conclusions: Findings suggest that Chinese Americans had similar rates of advance care discussions, completed conversations earlier, and had similar to higher rates of AD documentation compared to White patients. Further studies are needed to confirm our preliminary findings.

Dialysis decision-making process by Chinese American patients at an urban, academic medical center: a retrospective chart review

“…Additionally, literature shows that Chinese American families emphasize harmony and mutual reliance within the family [ 14 ] and a strong sense of filial piety [ 6 , 7 ]. These factors may move discussion away from consideration of non-dialytic care and towards dialysis.…”

“…However, the limited detail available in the records did not allow us to elucidate the specific role of filial piety, this attribute has been found to be associated with a preference for active medical management among Chinese families [ 29 – 31 ]. Chinese culture emphasizes respect for physicians [ 14 ], and it is possible that nephrologists can help families by framing treatment decision discussions to suggest that any kidney failure treatment choice can fulfill familial obligations ( e.g. , respecting patient’s wishes, offering additional support for care at home).…”

“…Tufts Medical Center is an academic medical center located in Boston’s Chinatown neighborhood. Approximately 10% of all patients receiving care at Tufts Medical Center are Chinese American [ 14 , 15 ] and approximately 22% of all patients in the on-site dialysis clinic operated by Dialysis Clinic, Inc. (DCI) are Chinese American. We undertook a retrospective chart review to explore the process and timing of dialysis decision making and initiation in Chinese American patients to provide quality kidney care for this population.…”

Community Member and Health Care Provider Perspectives on Communication With Chinese American Patients With Cancer: A Qualitative Study

“…Evidence supports the importance of a family-centered communication and care approach. 3,[37][38][39][40][41] Our study highlights that Chinese Americans want to be included in communication and care decisions, which diverges from the relatively common practice in China and among recent Chinese American immigrants of not disclosing a cancer or serious illness diagnosis to the patient because of family preference. 42,43 This lack of disclosure may be related to expected family roles, including filial piety, where adult children are expected to protect and ensure that their parents are comfortable at the end of life.…”