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Henderson RL, Zoucha R, Colbert A, Braxter BJ. Exploring Cultural Factors of Human Papillomavirus Vaccination Acceptance in African Americans: An Integrative Review. J Transcult Nurs 2022; 33:723-731. [PMID: 36197072 DOI: 10.1177/10436596221125899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccine can prevent HPV-related cancers. However, African Americans (AA) have a 30% higher incidence of HPV-related cervical cancer than Whites. The purpose of this integrative review is to explore cultural factors and beliefs impacting HPV vaccine decisions in AA adults. METHODOLOGY The Whittemore & Knafl model guided this review. Databases searched were PubMed, CINAHL, and Embase. Key terms included "human papillomavirus," "vaccine," "cultural values," "African American," and "adult." Inclusion criteria were AAs aged 18 years and over living in the United States. RESULTS A total of 634 articles were identified, and 20 studies published from 2010 to 2020 were used. Common factors influencing HPV vaccine decisions included religion, knowledge, physician recommendation, social network, attitudes, mistrust, benefits, and safety. DISCUSSION Limitations included omission of articles lacking AA representation, limited databases searched, and one-author-evaluated studies. Future studies to discover additional cultural factors influencing HPV vaccine acceptance are critical.
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Li IF, Huang SM, Lee CF, Chen YH, Hsiung Y. Perceptions of Behavioral Awareness, Intention, and Readiness for Advance Care Planning: A Mixed-Method Study among Older Indigenous Patients with Late-Stage Cancers in Remote Areas of Eastern Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168665. [PMID: 34444414 PMCID: PMC8391244 DOI: 10.3390/ijerph18168665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
The first Patient Right to Autonomy Act enacted in Asia in 2019 has enabled every Taiwanese citizen to plan for his/her end-of-life (EOL) in case of incompetency. Advance care planning (ACP) has been highly promoted for individuals with terminal, life-threatening illnesses, particularly in the mainstream society, and efforts have been made by the Taiwanese government to train health care providers in order to optimize patients' quality of dying. However, such advanced decisions and discussions regarding life-sustaining treatment and EOL care remain scarce among older ethnically minority patients. A multiple-case study employing a mixed-method (n = 9) was undertaken to explore indigenous patients' ACP perceptions. Both quantitative and qualitative information was obtained from indigenous patients, a minority group whose socio-economic and educational status are different from the general Taiwanese population. An initiative was made to describe ACP behavioral awareness, intention, and readiness of older terminal patients from four tribes with seven late-stage cancers in remote, mountainous areas of eastern Taiwan. Our findings showed that according to the Transtheoretical Model, terminal indigenous patients' ACP readiness was at a precontemplation stage. Their lack of fundamental ACP awareness, insufficient healthcare resources, life-sustaining value in a Christian faith context, and the prevalent health disparity in the remote communities have negatively affected indigenous patients' intention to participate in ACP. We provide suggestions to further promote ACP in this group and suggest that health information should be tailored at various readiness stages in order to overcome barriers and decrease ACP literacy discrepancies. This study calls attention to an understudied area of ACP behaviors, an overlooked need in EOL care for older cancer patients of unique cultural backgrounds, and the imperativeness to ensure cultural minority group's EOL care is consistent with patients' preferences.
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Affiliation(s)
- In-Fun Li
- Department of Nursing, Tamsui Branch, Mackay Memorial Hospital, New Taipei City 25160, Taiwan;
- Department of Nursing, MacKay Medical College, New Taipei City 25245, Taiwan; (S.-M.H.); (C.-F.L.); (Y.-H.C.)
| | - Sheng-Miauh Huang
- Department of Nursing, MacKay Medical College, New Taipei City 25245, Taiwan; (S.-M.H.); (C.-F.L.); (Y.-H.C.)
| | - Ching-Fang Lee
- Department of Nursing, MacKay Medical College, New Taipei City 25245, Taiwan; (S.-M.H.); (C.-F.L.); (Y.-H.C.)
| | - Yi-Heng Chen
- Department of Nursing, MacKay Medical College, New Taipei City 25245, Taiwan; (S.-M.H.); (C.-F.L.); (Y.-H.C.)
| | - Yvonne Hsiung
- Department of Nursing, MacKay Medical College, New Taipei City 25245, Taiwan; (S.-M.H.); (C.-F.L.); (Y.-H.C.)
- Correspondence:
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Smith-Howell ER, Hickman SE, Meghani SH, Perkins SM, Rawl SM. End-of-Life Decision Making and Communication of Bereaved Family Members of African Americans with Serious Illness. J Palliat Med 2016; 19:174-82. [PMID: 26840853 DOI: 10.1089/jpm.2015.0314] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study objective was to examine factors that influence African American (AA) family members' end-of-life care decision outcomes for a relative who recently died from serious illness. METHODS A cross-sectional descriptive study design was used. Binary logistic and linear regressions were used to identify factors associated with decision regret and decisional conflict. Forty-nine bereaved AA family members of AA decedents with serious illness who died two to six months prior to enrollment were recruited from the palliative care program in a safety net hospital and a metropolitan church in the Midwest. Measurements used were the Decisional Conflict, Decision Regret, Beliefs and Values, and Quality of Communication scales. RESULTS Family members who reported higher quality of communication with health care providers had lower decisional conflict. Family members of decedents who received comfort-focused care (CFC) had significantly less decision regret than family members of those who received life-prolonging treatment (LPT). Family members who reported stronger beliefs and values had higher quality of communication with providers and lower decisional conflict. CONCLUSIONS This research adds to a small body of literature on correlates of end-of-life decision outcomes among AAs. Although AAs' preference for aggressive end-of-life care is well-documented, we found that receipt of CFC was associated with less decision regret. To reduce decisional conflict and decision regret at the end of life, future studies should identify strategies to improve family member-provider communication, while considering relevant family member and decedent characteristics.
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Affiliation(s)
- Esther R Smith-Howell
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, Pennsylvania.,2 School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Susan E Hickman
- 3 School of Nursing, Indiana University , Indianapolis, Indiana.,5 Simon Cancer Center, Indiana University , Indianapolis, Indiana
| | - Salimah H Meghani
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, Pennsylvania.,2 School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Susan M Perkins
- 4 School of Medicine, Indiana University , Indianapolis, Indiana.,5 Simon Cancer Center, Indiana University , Indianapolis, Indiana
| | - Susan M Rawl
- 3 School of Nursing, Indiana University , Indianapolis, Indiana.,5 Simon Cancer Center, Indiana University , Indianapolis, Indiana
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End of Life in a Haitian American, Faith-Based Community: Caring for Family and Communal Unity. J Christ Nurs 2016; 34:E8-E18. [PMID: 27941464 DOI: 10.1097/cnj.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This article presents two models resulting from a grounded theory study of the end-of-life decision-making process for Haitian Americans. Successful access to this vulnerable population was achieved through the faith-based community. The first model describes this faith-based community of Haitian Americans. The second model describes the process used by families in this community who must make end-of-life healthcare decisions. Implications for nursing practice and caring science include a need to improve the congruence between the nursing care provided at this vulnerable time and the cultural values of a population.
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Dillon PJ, Basu A. African Americans and Hospice Care: A Culture-Centered Exploration of Enrollment Disparities. HEALTH COMMUNICATION 2016; 31:1385-1394. [PMID: 27007165 DOI: 10.1080/10410236.2015.1072886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill and of whom few were using hospice care services, this essay draws upon the culture-centered approach to report the findings of a grounded theory analysis of 39 interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. These findings have implications for understanding hospice experiences, promoting hospice access, and improving end-of-life care.
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Affiliation(s)
| | - Ambar Basu
- b Department of Communication , University of South Florida
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Romo RD, Wallhagen MI, Smith AK. Viewing Hospice Decision Making as a Process. Am J Hosp Palliat Care 2015; 33:503-10. [DOI: 10.1177/1049909115569592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research focused on understanding that the nature of hospice decision making has both described the characteristics of those who do and do not utilize hospice and identified many factors related to choosing hospice. However, this literature has not explored the underlying decision-making processes, limiting our understanding. We examine the extant literature and propose a framework that views hospice decisions as an evolving process, identify key factors that bear directly on this process, and discuss the contextual environment, including the idea of a decision maker triad. We end with a discussion of how this framework can be used to support clinical practice and future research. Our goal is to provide a framework from which to understand the end-of-life needs of all patients, no matter where they receive care.
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Affiliation(s)
- Rafael D. Romo
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
- San Francisco Veterans’ Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, CA, USA
| | - Margaret I. Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Alexander K. Smith
- San Francisco Veterans’ Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, CA, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
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LoPresti MA, Dement F, Gold HT. End-of-Life Care for People With Cancer From Ethnic Minority Groups: A Systematic Review. Am J Hosp Palliat Care 2014; 33:291-305. [PMID: 25550406 DOI: 10.1177/1049909114565658] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ethnic/racial minorities encounter disparities in healthcare, which may carry into end-of-life (EOL) care. Advanced cancer, highly prevalent and morbid, presents with worsening symptoms, heightening the need for supportive and EOL care. PURPOSE To conduct a systematic review examining ethnic/racial disparities in EOL care for cancer patients. DESIGN We searched four electronic databases for all original research examining EOL care use, preferences, and beliefs for cancer patients from ethnic/racial minority groups. RESULTS Twenty-five studies were included: 20 quantitative and five qualitative. All had a full-text English language article and focused on the ethnic/racial minority groups of African Americans, Hispanics Americans, or Asian Americans. Key themes included EOL decision making processes, family involvement, provider communication, religion and spirituality, and patient preferences. Hospice was the most studied EOL care, and was most used among Whites, followed by use among Hispanics, and least used by African and Asian Americans. African Americans perceived a greater need for hospice, yet more frequently had inadequate knowledge. African Americans preferred aggressive treatment, yet EOL care provided was often inconsistent with preferences. Hispanics and African Americans less often documented advance care plans, citing religious coping and spirituality as factors. CONCLUSION EOL care differences among ethnic/racial minority cancer patients were found in the processes, preferences, and beliefs regarding their care. Further steps are needed to explore the exact causes of differences, yet possible explanations include religious or cultural differences, caregiver respect for patient autonomy, access barriers, and knowledge of EOL care options.
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Affiliation(s)
- Melissa A LoPresti
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Fritz Dement
- Department of Medical Library, New York University School of Medicine, New York, NY, USA
| | - Heather T Gold
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Conner NE, Chase SK. Decisions and caregiving: end of life among blacks from the perspective of informal caregivers and decision makers. Am J Hosp Palliat Care 2014; 32:454-63. [PMID: 24707009 DOI: 10.1177/1049909114529013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This focus group study describes end-of-life caregiving and decision making among blacks from the perspective of the informal caregivers and decision makers. The Behavioral Model of Health Services Use framed the study. Five focus groups with a total of 53 informal caregivers/decision makers were conducted. A qualitative phenomenological approach was used for the data analysis. Findings are presented under the themes of end of life caregiving and decision making roles, dynamics and process, and beliefs and values. The common thread of care giving and decision-making within relationship and six subthemes were identified. Findings also suggest the need for support and inclusion of designated informal caregivers and decision-makers in the advance care planning process early in the disease trajectory.
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Affiliation(s)
- Norma E Conner
- University of Central Florida, College of Nursing, Orlando, FL, USA
| | - Susan K Chase
- University of Central Florida, College of Nursing, Orlando, FL, USA
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Caregiver Strain, Quality of Life, and Symptom Distress Among Dyads of African American Cancer Survivors and Caregivers. J Hosp Palliat Nurs 2013. [DOI: 10.1097/njh.0b013e3182953eb3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Campbell CL, Baernholdt M, Yan G, Hinton ID, Lewis E. Racial/ethnic perspectives on the quality of hospice care. Am J Hosp Palliat Care 2012; 30:347-53. [PMID: 22952128 DOI: 10.1177/1049909112457455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents. Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001).
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Affiliation(s)
- Cathy L Campbell
- The University of Virginia, School of Nursing, Charlottesville, VA 22908, USA.
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Conner NE. Predictive factors of hospice use among Blacks: applying Andersen's Behavioral Model. Am J Hosp Palliat Care 2011; 29:368-74. [PMID: 22072640 DOI: 10.1177/1049909111425227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this prospective, correlational study was to examine the differential ability of demographic variables, beliefs, and values about end-of-life, spirituality, and social relationships to predict hospice use among blacks. The framework for this study was the Behavioral Model of Health Services Use. Data were collected from 104 terminally ill black men and women recruited from 6 inpatient and outpatient settings. Only 34% of the individuals participated in hospice services. Chi-square, sequential, and stepwise logistic regressions revealed that the best predictive model consisted of presence of a caregiver, having a religious affiliation, and male gender. Together these factors predicted 13.7% to 19% of hospice use among blacks. Health care providers can use these findings in planning care for patients early in their disease trajectory.
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Affiliation(s)
- Norma E Conner
- University of Central Florida, College of Nursing, Orlando, FL 32826, USA.
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Melhado L, Bushy A. Exploring Uncertainty in Advance Care Planning in African Americans. Am J Hosp Palliat Care 2011; 28:495-500. [DOI: 10.1177/1049909110398005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.
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Affiliation(s)
- Lolita Melhado
- Lee Memorial Health System, Gulf Coast Medical Center, FL, USA
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