1
|
Macedo JC, Castro L, Nunes R. Attitudes of the Portuguese population towards advance directives: an online survey. BMC Med Ethics 2024; 25:40. [PMID: 38570826 PMCID: PMC10988855 DOI: 10.1186/s12910-024-01043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Advance directives (ADs) were implemented in Portugal in 2012. Although more than a decade has passed since Law 25/2012 came into force, Portuguese people have very low levels of adherence. In this context, this study aimed to identify and analyse the attitudes of people aged 18 or older living in Portugal towards ADs and to determine the relationships between sociodemographic variables (gender/marital status/religion/level of education/residence/whether they were a health professional/whether they had already drawn up a living will) and people's attitudes towards ADs. METHODS An online cross-sectional analytical study was conducted using a convenience sample. For this purpose, a request (email) that publicized the link to a -form-which included sociodemographic data and the General Public Attitudes Toward Advance Care Directives (GPATACD) scale-was sent to 28 higher education institutions and 30 senior universities, covering all of mainland Portugal and the islands (Azores and Madeira). The data were collected between January and February 2023. RESULTS A total of 950 adults from completed the online form. The lower scores (mean 1 and 2) obtained in most responses by applying the GPATACD scale show that the sample of the Portuguese population has a very positive attitude towards ADs. The data showed that women, agnostics/atheists, health professionals and those who had already made a living will had more positive attitudes (p < 0.001) towards ADs. There were no statistically significant differences in the attitudes of the Portuguese population sample towards ADs in relation to marital status, education level, and residence. CONCLUSION The results obtained enable us to confirm that this sample of the Portuguese population has a positive attitude towards ADs. We verify that there are certain fringes of this sample with certain sociodemographic characteristics (women, agnostics/atheists, health professionals and those who had already made a living will) that have a more positive attitude towards ADs. This data could facilitate the implementation and adjustment of relevant measures, particularly in the field of health education and aimed at groups with less favourable attitudes, to increase the effectiveness of voluntary exercise of citizens' autonomy in end-of-life care planning.
Collapse
Affiliation(s)
- João Carlos Macedo
- Nursing School, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal.
| | - Luísa Castro
- Centre for Health Technology and Services Research (CINTESIS@RISE), Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, 4200-450, Portugal
| | - Rui Nunes
- Center of Bioethics of the Faculty of Medicine, University of Porto, Porto, 4200-450, Portugal
| |
Collapse
|
2
|
Choi S, Ko H. Factors affecting advance directives completion among older adults in Korea. Front Public Health 2024; 12:1329916. [PMID: 38371241 PMCID: PMC10869548 DOI: 10.3389/fpubh.2024.1329916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Advance directives (ADs) provide an opportunity for patients to enhance the quality of their end-of-life care and prepare for a dignified death by deciding treatment plans. The purpose of this study was to explore the multiple factors that influence the advance directives completion among older adults in South Korea. Methods This was a secondary analysis of a cross-sectional study of 9,920 older adults. The differences in ADs based on subjects' sociodemographic characteristics, health-related characteristics, and attitude toward death were tested using the chi-squared and t-test. A multinomial logistic regression model was used to identify the influencing factor of ADs. Results The number of chronic diseases, number of prescribed medications, depression, insomnia, suicide intention, and hearing, vision, or chewing discomfort were higher in the ADs group compared to the non-ADs group. The influencing factors of the signing of ADs included men sex, higher education level, exercise, death preparation education, lower awareness of dying-well, and experience of fracture. Conclusion Information dissemination regarding ADs should be promoted and relevant authorities should consider multiple options to improve the physical and psychological health of older adults, as well as their attitude toward death to increase the ADs completion rate.
Collapse
Affiliation(s)
| | - Hana Ko
- College of Nursing, Gachon University, Yeonsu-gu, Incheon, Republic of Korea
| |
Collapse
|
3
|
Chung JE, Karass S, Choi Y, Castillo M, Garcia CA, Shin RD, Tanco K, Kim LS, Hong M, Pan CX. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Filipino American and Korean American Patients. J Palliat Med 2024; 27:104-111. [PMID: 37200523 DOI: 10.1089/jpm.2023.0255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
As of 2019, there are 4.2 million Filipino Americans (FAs) and 1.9 million Korean Americans (KAs) in the United States, largely concentrated in New York, California, Texas, Illinois, and Washington. In both populations, similar to the broader U.S. culture, one can find health literacy gaps around understanding and utilizing palliative care. In this article, we provide 10 cultural pearls to guide clinicians on how to sensitively approach FA and KA groups when addressing palliative and end-of-life (EOL) discussions. We fully celebrate that every person is an individual and care should be tailored to each person's goals, values, and preference. In addition, there are several cultural norms that, when appreciated and celebrated, may help clinicians to improve serious illness care and EOL discussions for members of these populations.
Collapse
Affiliation(s)
- Jenny E Chung
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Susan Karass
- Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Yoonhee Choi
- Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Matthew Castillo
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Christine A Garcia
- Division of Hematology and Medical Oncology, Department of Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, New York, USA
| | - Richard D Shin
- Department of Emergency Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Kimberson Tanco
- Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laura S Kim
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, New York-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Michin Hong
- School of Social Work, Indiana University, Indianapolis, Indiana, USA
| | - Cynthia X Pan
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| |
Collapse
|
4
|
Pei Y, Qi X, Zhu Z, Zhang W, Tsay RM, Wu B. The informal discussion of advance care planning among Chinese older adults: Do education and social media use matter? Geriatr Nurs 2024; 55:1-5. [PMID: 37956600 PMCID: PMC10917644 DOI: 10.1016/j.gerinurse.2023.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
This study aimed to examine and compare the associations between education, social media use, and advance care planning (ACP) discussion among Chinese older adults in mainland China (Wuhan), Taiwan (Taichung), and the United States (Honolulu). Community-dwelling older adults (≥ 55) were recruited from 2017 to 2018. The ACP discussion rate in Wuhan, Taichung, and Honolulu were 15.2 %, 19.2 %, and 31.3 %, respectively. Logistic regression models revealed that education was positively associated with ACP discussion in Taichung and Honolulu. Social media use was positively associated with ACP discussions in Wuhan and Honolulu, and it attenuated the association between education and ACP discussion in Honolulu. The present study contributes to previous studies by comparing the associations between education, social media use, and ACP discussion in different settings within the same ethnicity. Policy and practice implications were also discussed.
Collapse
Affiliation(s)
- Yaolin Pei
- Rory Meyers College of Nursing, New York University, USA
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University, USA
| | - Zheng Zhu
- Rory Meyers College of Nursing, New York University, USA
| | - Wei Zhang
- Department of Sociology, University of Hawai'i at Mānoa, USA
| | | | - Bei Wu
- Rory Meyers College of Nursing, New York University, USA.
| |
Collapse
|
5
|
Kim B, Lee J, Choi YS. Public awareness of advance care planning and hospice palliative care: a nationwide cross-sectional study in Korea. BMC Palliat Care 2023; 22:205. [PMID: 38151721 PMCID: PMC10752019 DOI: 10.1186/s12904-023-01333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023] Open
Abstract
CONTEXT Advance care planning (ACP) and hospice palliative care (HPC) have potential benefits for individuals and health systems. Public awareness of them might increase their acceptance. OBJECTIVES To examine public awareness of ACP and HPC and related factors including individuals' experience of health care among Korean population. METHODS A cross-sectional study based on a nationally representative sample was conducted. Data from participants aged 15 years or older were examined. Socio-demographic characteristics, health-related factors, health care experience in the past year, and awareness of ACP and HPC were analyzed. Subgroup analysis was conducted to determine associations between specific experiences during outpatient visit and awareness of ACP and HPC. RESULTS Of a total of 13,546 subjects, 39.3% and 35.7% reported awareness of ACP and HPC, respectively. About half (48.6%) of participants reported that they were completely unaware of ACP or HPC. Recent outpatient visit was positively associated with HPC awareness. Participants were more likely to recognize ACP or HPC if they had experience in hospitalization and health checkup over the past year and had trust in the medical system. Conversely, participants who had inadequate health care access due to cost burden showed low awareness of ACP and HPC. CONCLUSION There was a lack of public awareness of ACP and HPC. There were significant differences depending on various factors, especially individual health care experiences. Appropriate interventions are needed to facilitate discussion of ACP and HPC, thereby increasing public awareness.
Collapse
Affiliation(s)
- Boram Kim
- Division of Health Policy, Bureau of Health Policy, Ministry of Health and Welfare, Sejong-si, Republic of Korea
| | - Junyong Lee
- Department of Family Medicine, Veterans Health Service (VHS) Medical Center, Seoul, Republic of Korea
| | - Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
| |
Collapse
|
6
|
Lim MK, Wong PS, Othman S, Mohd Mydin FH, Lim PS, Lai PSM. A Systematic Review of Non-Seriously Ill Community-Dwelling Asians' Views on Advance Care Planning. J Am Med Dir Assoc 2023; 24:1831-1842. [PMID: 37844872 DOI: 10.1016/j.jamda.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To systematically synthesize the views of community-dwelling Asians on Advance care planning and to summarize the factors and reasons affecting their uptake of ACP. DESIGN Mixed-methods systematic review (PROSPERO: CRD42018091033). SETTING AND PARTICIPANTS Asian adults (≥18 years old) living in the community globally. METHODS Medline (Ovid), Web of Science, CINAHL (EBSCO), Open Grey, and Google Scholar were searched from inception to June 30, 2022. Qualitative, quantitative, or mixed-methods studies reporting on the views of non-seriously ill community-dwelling Asian adults on ACP or the factors influencing their ACP uptake were included. Secondary research, studies not published in English, or studies not available as full text were excluded. Two independent teams of researchers extracted data, assessed methodologic quality, and performed the data analysis. Data analysis was conducted using the multistep convergent integrated approach based on Joanna Briggs Institute methodology for mixed-methods systematic review. RESULTS Fifty-eight studies were included. Non-seriously ill community-dwelling Asians were willing to engage in ACP (46.5%-84.4%) although their awareness (3.1%-42.9%) and uptake of ACP remained low (14.0%-53.4%). Background factors (sociodemographic factors, and health status, as well as experience and exposure to information) and underlying beliefs (attitude toward ACP, subjective norm, and perceived behavioral control) were found to affect their uptake of ACP. A conceptual framework was developed to facilitate a proper approach to ACP for this population. CONCLUSIONS AND IMPLICATIONS A flexible approach toward ACP is needed for non-seriously ill community-dwelling Asians. There is also a need to raise end-of-life and ACP literacy, and to explore ways to narrow the gap in the expectations and implementation of ACP so that trust in its effective execution can be built.
Collapse
Affiliation(s)
- Mun Kit Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Pharmacy, Monash University, Selangor, Malaysia
| | - Pei Se Wong
- International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajaratulnisah Othman
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Fadzilah Hanum Mohd Mydin
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Pei Shan Lim
- Anaesthetic Department, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
| |
Collapse
|
7
|
Payne J, Sadeghi MA, Liu J, Siess S, Moyer A. The comprehensiveness and comprehensibility of publicly-available, state-approved advance directive documents. PSYCHOL HEALTH MED 2023; 28:3131-3148. [PMID: 35477323 DOI: 10.1080/13548506.2022.2067341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
The COVID-19 pandemic has increased attention to end-of-life decision-making and advance care planning. Advance directives (ADs) are documents that express an individual's wishes regarding their medical care if they are incapacitated and may appoint someone to make decisions for them. The purpose of the current study was to evaluate the comprehensiveness and comprehensibility of the widely available state-approved AD documents provided to the public online. Their content was coded using a grounded theory approach, and the reading level of the documents was assessed. Preferences related to important issues, such as pain relief, were commonly included (92.2% of forms), but other issues, such as whether someone would approve of artificial respiration (39.2%) or CPR (35.3%), were less often addressed. The average reading level of the forms (M = grade 7.64; SD = 1.28) was above the recommended 5th grade level. Overall, there was meaningful variability in the comprehensiveness and comprehensibility of AD documents, suggesting incompatibility for those recording their end-of-life preferences across states and the need for future work to increase their user-friendliness and ability to record authentic advance care wishes.
Collapse
Affiliation(s)
- Jackelyn Payne
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | | | - Jaimie Liu
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Samantha Siess
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Anne Moyer
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
8
|
Lee HY, Noh H, Choi E, Lee LH. Social determinants of willingness to discuss end-of-life care with family and doctors among Korean American immigrants: Findings from a cross-sectional survey in Alabama. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6056-e6066. [PMID: 36164279 DOI: 10.1111/hsc.14043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Prior research reported lower engagement in end-of-life discussions and planning among Korean American (KA) immigrants; however, there is a dearth of research investigating factors associated with their willingness to discuss their end-of-life care wishes. This study aimed to examine the willingness to have end-of-life discussions with family and doctors among KA immigrants and social determinants of health (SDH) associated with willingness. A self-administered, cross-sectional survey was conducted with a convenience sample of 259 KA immigrants recruited from two counties in Alabama. Demographic, health, acculturation and SDH information were collected. Logistic regression analyses were conducted to examine associations between SDH and willingness for end-of-life discussion with family and doctors, respectively. The majority of the sample was willing to discuss end-of-life care with family (94%) and doctors (82%). Those with hospice awareness were more likely to have willingness for discussion with family (OR = 27.70, p < 0.001) and doctors (OR = 5.01, p < 0.001). Those who could not see a doctor because of cost (OR = 0.03, p < 0.01) and who had higher threats to interpersonal safety (OR = 0.74, p < 0.05) were less likely to have willingness for discussion with family. Those who had more chronic conditions (OR = 0.60, p < 0.05) and higher levels of social isolation (OR = 0.77, p < 0.05) were less likely to have willingness for discussion with doctors. The SDH identified in this study should be considered in developing interventions to promote end-of-life discussions in the KA immigrant community. Future research should investigate the associations explored in this study in a larger and more representative sample.
Collapse
Affiliation(s)
- Hee Y Lee
- Research/Endowed Academic Chair on Social Work and Health, School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Hyunjin Noh
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Eunyoung Choi
- School of Global Public Health, New York University, New York, New York City, USA
| | - Lewis H Lee
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| |
Collapse
|
9
|
A Qualitative Exploration of End-of-Life Care Planning With Korean Americans: Awareness, Attitudes, Barriers, and Preferences. J Hosp Palliat Nurs 2022; 24:E212-E218. [PMID: 35666765 DOI: 10.1097/njh.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study aimed to explore how Korean American older adults viewed and anticipated engaging in end-of-life (EOL) care planning. An exploratory qualitative research design was adopted for the study, and data were collected through 3 focus group interviews. A total of 30 Korean American older adults 65 years or older participated in the study. A total of 10 themes emerged and were organized into 5 categories: (1) awareness (varying experience in EOL care planning and insufficient understanding about advance directives), (2) attitudes (comfort with talking about EOL and favorable views toward EOL planning), (3) barriers (concerns about noncompliance and concerns about change of mind), (4) preference for natural dying (life-sustaining treatment as added pain and suffering and no meaning of life when relying on life-sustaining treatment), and (5) preference for EOL planning process (EOL planning initiated by physicians and involvement of close family members). This exploratory study provides crucial insights into awareness and concerns regarding EOL care planning among Korean American older adults, updating existing evidence about their EOL needs. These findings support a culturally grounded approach to promote EOL planning for ethnic/racial minority groups.
Collapse
|
10
|
Nakao-Hayashizaka KC. End-of-Life Preparedness Among Japanese Americans: A Community Survey. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:216-234. [PMID: 35815782 DOI: 10.1080/15524256.2022.2093312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to investigate the level of preparedness among Japanese American older adults for life's end by examining their knowledge, preferences, and arrangements for end-of-life issues. A total of 248 community dwelling Japanese Americans aged 50 and older participated in the study. The cross-sectional survey results indicated that participants believed they were well-informed about end-of-life issues and well-prepared for their lives' end. While most participants were in favor of making end-of-life arrangements, particularly with regard to making a will/living trust, creating an advance health care directive, appointing a health care agent, and funeral planning, relatively few favored life-prolonging treatment or planning for organ donation. They placed a high value on natural death and family-centered decision-making processes. These findings highlight the importance of awareness and cultural humility for social workers when providing culturally informed services at life's end to diverse Americans, including Japanese American older adults and their families.
Collapse
|
11
|
An HJ, Jeon HJ, Chun SH, Jung HA, Ahn HK, Lee KH, Kim MH, Hee Kim J, Cheon J, Koh SJ. Discussing POLST-facilitated hospice care enrollment in patients with terminal cancer. Support Care Cancer 2022; 30:7431-7438. [PMID: 35622149 DOI: 10.1007/s00520-022-07143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE A multicenter prospective study to evaluate the feasibility of Physician Orders for Life-Sustaining Treatment (POLST) in oncology practice was conducted between June and December 2017. Factors associated with POLST completion and follow-up outcomes were analyzed. METHODS Patients with terminal cancer, aged ≥ 20 years and capable of communicating, were enrolled from seven hospitals. Demographic data were collected and updated in February 2021. Descriptive statistics and logistic regression analyses were conducted. RESULTS Among 336 patients, 105 (31.3%) completed POLST, which was more common in male (p = 0.029), patients with better performance (p < 0.001), longer duration of follow-up (p = 0.037), and those living with children (p = 0.023). Male (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.17-3.51; p = 0.012), having good performance status (OR, 2.38; 95% CI, (1.35-4.19); p = 0.003), transferred from other departments (OR, 0.50; 95% CI, (0.26-0.98); p = 0.045), and living with children (OR, 1.94; 95% CI, (1.11-3.47); p = 0.020) were significant predictors of POLST completion. Patients who completed POLST were more likely to enroll in hospice care (p = 0.012) or experience out-of-hospital death (p = 0.016) at end-of-life (EOL). POLST completion showed a strong association with hospice enrollment at EOL (OR, 2.61; 95% CI, (1.08-6.32); p = 0.033). CONCLUSION Gender, patient performance, timing of POLST discussion, and type of household were associated with POLST completion. Earlier discussions on POLST could reinforce hospice enrollment or non-aggressive EOL care.
Collapse
Affiliation(s)
- Ho Jung An
- Department of Medical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Jeong Jeon
- Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
| | - Sang Hoon Chun
- Division of Medical Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Ae Jung
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Dongtan, South Korea
| | - Hee Kyung Ahn
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Kyung Hee Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Min-Ho Kim
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Ju Hee Kim
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea
| | - Jaekyung Cheon
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea.
| |
Collapse
|
12
|
Tsai WT, Chen CM, Chung MC, Tsai PY, Liu YT, Tang FC, Lin YL. Important Factors Influencing Willingness to Participate in Advance Care Planning among Outpatients: A Pilot Study in Central Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5266. [PMID: 35564659 PMCID: PMC9101214 DOI: 10.3390/ijerph19095266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022]
Abstract
Advance care planning (ACP) and advance directives (ADs) ensure patient autonomy in end-of life care. The number of ADs made and followed in Taiwan is still lacking. This study aimed to determine the factors that influence the willingness to participate in ACP among outpatients in Taiwan. In this study, we conducted a cross-sectional survey based on convenient sampling methods. The questionnaire included questions about participants' basic sociodemographic information, knowledge of ACP, and awareness of ACP. A total of 198 adults who were outpatients of a family medicine clinic in an affiliated hospital in Taiwan were recruited. The associations between each variable were evaluated using the χ2 test. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the logistic regression method to examine the influence of each variable on willingness to participate in ACP. Being happy and being a healthcare professional were positively correlated with ACP participation. A lack of ACP knowledge (OR = 0.30 in model A and OR = 0.42 in model C), valuing "Reducing families' end-of-life decision-making burden" (OR = 2.53 in model B and OR = 2.65 in model C), and a "Belief in a good death" (OR = 4.02 in model B and OR = 4.10 in Model C) were the main factors affecting subjects' willingness to participate in ACP. Knowing which factors influence willingness to participate in ACP helps in the promotion of ACP. Continuously educating both the general public and healthcare professionals strengthens knowledge about the right to autonomy, about its associated laws, and about the ACP process, and thus, programs should be created to provide this education. Additionally, taking into account the differences between cultures can be helpful.
Collapse
Affiliation(s)
- Wan-Ting Tsai
- Department of Family Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (W.-T.T.); (M.-C.C.); (P.-Y.T.); (Y.-T.L.)
| | - Chun-Min Chen
- Big Data Center, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Ming-Cheng Chung
- Department of Family Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (W.-T.T.); (M.-C.C.); (P.-Y.T.); (Y.-T.L.)
| | - Pei-Yu Tsai
- Department of Family Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (W.-T.T.); (M.-C.C.); (P.-Y.T.); (Y.-T.L.)
| | - Yen-Tzu Liu
- Department of Family Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (W.-T.T.); (M.-C.C.); (P.-Y.T.); (Y.-T.L.)
- Big Data Center, Changhua Christian Hospital, Changhua 500, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Holistic Wellness, Mingdao University, Changhua 500, Taiwan
- Post Baccalaureate Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Feng-Cheng Tang
- Department of Occupational Medicine, Changhua Christian Hospital, Changhua 500, Taiwan;
- Department of Leisure Services Management, Chaoyang University of Technology, Taichung 413, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ying-Li Lin
- Department of Family Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (W.-T.T.); (M.-C.C.); (P.-Y.T.); (Y.-T.L.)
| |
Collapse
|
13
|
Kim B, Choi J, Lee I. Factors Associated with Advance Directives Documentation: A Nationwide Cross-Sectional Survey of Older Adults in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073771. [PMID: 35409452 PMCID: PMC8997513 DOI: 10.3390/ijerph19073771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022]
Abstract
Advance directives (ADs) can support autonomy in making healthcare decisions and minimize unnecessary discomfort during the treatment process at the end of life (EOL). This study aimed to investigate the factors that influence AD documentation among community-dwelling older adults. We used data from the National Survey of Older Koreans which was conducted nationwide in 2020. Data from participants aged 65 years or older were extracted using stratified multistage cluster sampling and the survey was conducted through one-on-one interviews. A total of 9920 older adults were included in this study: 421 respondents (4.7%) claimed that they had prepared for AD. Multivariable logistic regression analysis showed that being 75 years or older, having higher educational attainment, higher income, having any chronic disease(s), being screened for dementia in the past, being against futile life-sustaining treatment, taking a lecture on death and being registered for organ donation were positively associated with AD. Furthermore, when health was rated as average, it was associated with reduced odds of AD documentation compared when health was rated as good. These results suggest that more targeted efforts are required to promote EOL discussions among older adults.
Collapse
Affiliation(s)
- Boram Kim
- Division of Health Policy, Bureau of Health Policy, Ministry of Health and Welfare, Sejong-si 30113, Korea;
| | - Jiyeon Choi
- Division of Medical Law & Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Ilhak Lee
- Division of Medical Law & Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul 03722, Korea;
- The Asian Institute of Bioethics and Health Law, College of Medicine, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-2538
| |
Collapse
|
14
|
Lim MK, Lai PSM, Lim PS, Wong PS, Othman S, Mydin FHM. Knowledge, attitude and practice of community-dwelling adults regarding advance care planning in Malaysia: a cross-sectional study. BMJ Open 2022; 12:e048314. [PMID: 35165104 PMCID: PMC8845205 DOI: 10.1136/bmjopen-2020-048314] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to assess the knowledge, attitude and practice (KAP) among community-dwelling adults in Malaysia regarding advance care planning (ACP), and its associated factors. DESIGN This cross-sectional study was conducted from July-September 2018. SETTING This study was conducted at the University Malaya Medical Centre, Kuala Lumpur, Malaysia. PARTICIPANTS We recruited community-dwelling adults (ambulatory care patients or their accompanying persons) who were ≥21 years old and able to understand English or Malay. A 1:10 systematic sampling procedure was used. Excluded were community-dwelling adults with intellectual disabilities or non-Malaysian accompanying persons. A trained researcher administered the validated English or Malay Advance Care Planning Questionnaire at baseline and 2 weeks later. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the KAP regarding ACP. The secondary outcomes were factors associated with KAP. RESULTS A total of 385/393 community-dwelling adults agreed to participate (response rate 98%). Only 3.1% of the community-dwelling adults have heard about ACP and 85.7% of them felt that discussion on ACP was necessary after explanation of the term. The desire to maintain their decision-making ability when seriously ill (94.9%) and reducing family burden (91.6%) were the main motivating factors for ACP. In contrast, resorting to fate (86.5%) and perceived healthy condition (77.0%) were the main reasons against ACP. Overall, 84.4% would consider discussing ACP in the future. Community-dwelling adults who were employed were less likely to know about ACP (OR=0.167, 95% CI 0.050 to 0.559, p=0.004) whereas those with comorbidities were more likely to favour ACP (OR=2.460, 95% CI 1.161 to 5.213, p=0.019). No factor was found to be associated with the practice of ACP. CONCLUSIONS Despite the lack of awareness regarding ACP, majority of community-dwelling adults in Malaysia had a positive attitude towards ACP and were willing to engage in a discussion regarding ACP after the term 'ACP' has been explained to them.
Collapse
Affiliation(s)
- Mun Kit Lim
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Pei Shan Lim
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Pei Se Wong
- School of Pharmacy, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajaratulnisah Othman
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Fadzilah Hanum Mohd Mydin
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| |
Collapse
|
15
|
Hong M, Kim K. Advance care planning among ethnic/racial minority older adults: Prevalence of and factors associated with informal talks, durable power of attorney for health care, and living will. ETHNICITY & HEALTH 2022; 27:453-462. [PMID: 32126801 DOI: 10.1080/13557858.2020.1734778] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Given the ethnic/racial disparities in end-of-life care, this study aimed to describe and identify factors affecting engagement in three types of advance care planning including informal talk, living will, and durable power of attorney for health care among ethnic/racial minority older adults. Living will refers to any written instruction about medical treatments at the end-of-life while durable power of attorney for health care allows someone to make a health care decision when an individual is incapable of making a reasoned decision. DESIGN We used a subset of racial/ethnic minority groups drawn from the second wave of the National Health Aging and Trends Survey (n = 543) collected in 2012. RESULTS The descriptive result showed that informal talk (60%) happened most followed by durable power of attorney for health care (30%) and living will (26.5%) completion. Multivariate logistic regression analyses found that higher education and lower preference toward life-sustaining treatment were associated with engagement in all three types of advance care planning. Having multimorbidity and U.S. born were associated with having informal talk. Non-Hispanic others were more likely to have informal talk and complete durable power of attoreny for health care to compared to Blacks. Furthermore, married older adults were more likely to complete living wills compared to those separated/divorced or never married. CONCLUSIONS Our findings about different factors affecting engagement in advance care planning indicate that we may need targeted approaches to promote each type of advance care planning for ethnic/racial minority older adults.
Collapse
Affiliation(s)
- Michin Hong
- Indiana University School of Social Work, Indianapolis, IN, USA
| | - Kyeongmo Kim
- Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
16
|
Quach BI, Qureshi D, Talarico R, Hsu AT, Tanuseputro P. Comparison of End-of-Life Care Between Recent Immigrants and Long-standing Residents in Ontario, Canada. JAMA Netw Open 2021; 4:e2132397. [PMID: 34726744 PMCID: PMC8564577 DOI: 10.1001/jamanetworkopen.2021.32397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Recent immigrants face unique cultural and logistical challenges that differ from those of long-standing residents, which may influence the type of care they receive at the end of life. OBJECTIVE To compare places of care among recent immigrants and long-standing residents in Canada in the last 90 days of life. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used linked health administrative data on individuals from Ontario, Canada, who died between January 1, 2013, and December 31, 2016, extracted on February 26, 2020. Individuals were categorized by immigration status: recent immigrants (since 1985) and long-standing residents. Data were analyzed from December 27, 2019, to February 26, 2020. EXPOSURES All decedents who immigrated to Canada between 1985 and 2016 were classified as recent immigrants. Subgroup analyses assessed the association of region of origin. MAIN OUTCOMES AND MEASURES The main outcome was place of care, including institutional and noninstitutional settings, in the last 90 days of life. Descriptive statistics were used to compare characteristics and health service utilization among recent immigrants and long-standing residents. Negative binomial regression models estimated the rate ratios (RR) of using acute care and long-term care in the last 90 days of life. RESULTS A total of 376 617 deceased individuals (median [IQR] age, 80 [68-88] years; 187 439 [49.8%] women and 189 178 [50.2%] men) were identified, among whom 22 423 (6.0%) were recent immigrants; recent immigrants were younger than long-standing residents (median [IQR] age, 76 [60-85] years vs 81 [69-88] years; P < .001), more likely to be living in lower income neighborhoods (12 357 immigrants [55.1%] vs 166 017 long-standing residents [46.9%] in the lower 2 income quintiles; P < .001), and had a higher Charlson Index score (score ≥5, 6294 immigrants [28.1%] vs 74 809 long-standing residents [21.1%]; P < .001). In the last 90 days of life, recent immigrants spent more days in intensive care units than long-standing residents (mean [SD], 2.64 [8.73] days vs 1.47 [5.70] days; P < .001), while long-standing residents spent more days using long-term care than recent immigrants (mean [SD], 19.49 [35.81] days vs 10.45 [27.42] days; P < .001). Being a recent immigrant was associated with a greater likelihood of acute inpatient care use (RR, 1.21; 95% CI, 1.18-1.24) and lower likelihood of long-term care use (RR, 0.66; 95% CI, 0.63-0.70), after adjusting for covariates. CONCLUSIONS AND RELEVANCE These findings suggest that at the end of life, recent immigrants were significantly more likely to receive inpatient and intensive care unit services and die in acute care settings compared with long-standing residents. Further research is needed to examine differences in care preference and disparities for immigrant groups of different origins.
Collapse
Affiliation(s)
- Bradley I. Quach
- Faculty of Sciences, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | | | - Amy T. Hsu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- ICES, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| |
Collapse
|
17
|
Factors associated with willingness to complete advance directives in older adults. Geriatr Nurs 2021; 42:1042-1047. [PMID: 34256154 DOI: 10.1016/j.gerinurse.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
This study aimed to examine the factors associated with willingness to complete advance directives (ADs) in community-dwelling older adults. In total, 121 community-dwelling older adults in Korea completed the questionnaires inquiring about their willingness and perceptions in completing ADs (susceptibility, severity, benefits, barriers, and cues to action), which were based on the Health Belief Model. The mean score for willingness to complete ADs was 6.2 (SD = 3.6). A multiple linear regression analysis showed that higher scores of perceived severity (β = 0.199, p = 0.021), perceived benefits (β = 0.221, p = 0.016), and cues to action (β = 0.159, p = 0.030) were associated with a greater willingness to complete ADs. However, higher scores of perceived barriers (β = -0.409, p < 0.001) were likely to lower the willingness to complete ADs. This study highlights that future interventions aimed at increasing AD completion rates in older adults should consider improving perceived severity, benefits, and cues to action and minimizing perceived barriers.
Collapse
|
18
|
Park M. Increasing Advance Care Planning Conversations Among Korean Americans Through a Faith Community Nurse Intervention. J Christ Nurs 2021; 38:187-193. [PMID: 34085657 DOI: 10.1097/cnj.0000000000000839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Minority populations have lower rates of advance care planning (ACP) than the general population. Faith community nurses (FCNs) can facilitate ACP training to improve end-of-life care outcomes for patients and caregivers. A nurse-led ACP training delivered to a primarily Korean American faith community increased the number of families who discussed end-of-life care values and wishes. Considerations for ACP outreach to Korean Americans and implications for FCNs are discussed.
Collapse
Affiliation(s)
- Morgan Park
- Morgan Park, DNP, RN , has designed, led, and assisted with community-based advance care planning programs through a community task force under the New Jersey Health Care Quality Institute
| |
Collapse
|
19
|
Kawakami A, Kwong EW, Lai CK, Song MS, Boo S, Yamamoto-Mitani N. Advance care planning and advance directive awareness among East Asian older adults: Japan, Hong Kong and South Korea. Geriatr Gerontol Int 2020; 21:71-76. [PMID: 33217170 DOI: 10.1111/ggi.14086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/28/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Abstract
AIM Population aging is a global phenomenon, and East Asian countries are no exception. However, the use of advance care planning (ACP) and advance directives (ADs) are not widespread in East Asia. This study aimed to examine the awareness of ACP/ADs and its related factors among community-dwelling older persons in Japan, Hong Kong and South Korea. METHODS This was a cross-sectional, cross-cultural questionnaire conducted among a convenience sample of community-dwelling persons. The questionnaire included information regarding awareness of ACP/ADs and personal information. Multiple logistic regression was used assess relationships between awareness of ACP/ADs and potential related factors. RESULTS The sample consisted of 404 community-dwelling older adults: 174 (43.0%) from Japan, 132 (32.7%) from Hong Kong and 98 (24.3%) from South Korea. In total, 122 participants (30.2%) had heard of ACP/ADs. Multiple logistic regression analysis revealed that an educational level >12 years was significantly associated with increased ACP/ADs awareness (adjusted odds ratio [AOR]: 2.19, 95% confidence interval (CI): 1.18-4.07, P = 0.01). The rate of those who have heard of ACP/ADs was significantly higher among Japanese than South Koreans were (AOR: 4.54, 95% CI: 1.64-12.58, P < 0.01), those from Hong Kong than South Korea (AOR: 5.15, 95% CI 1.89-14.0, P < 0.01) after some variables with significant differences among the three countries were controlled. CONCLUSIONS In particular, support tailored to the targets' educational levels will be required. It is also suggested that support is needed to enhance awareness of ACP/ADs in East Asia, although there is a difference in degree of awareness among the three countries. Geriatr Gerontol Int 2021; 21: 71-76.
Collapse
Affiliation(s)
- Aki Kawakami
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Enid Wy Kwong
- School of Nursing, Putian University, Putian, China.,School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Claudia Ky Lai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.,Division of Nursing Studies, School of Continuing Education, The Hong Kong Baptist University, Kowloon, Hong Kong
| | - Mi Sook Song
- College of Nursing Research Institute of Nursing Sciences, Ajou University, Suwon, South Korea
| | - Sunjoo Boo
- College of Nursing Research Institute of Nursing Sciences, Ajou University, Suwon, South Korea
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Homecare & Long-term Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
20
|
Wang K, Liu Y, Sun F, Kong D, Jiang L, Wu B. Advance Directive Completion and Its Associated Factors Among Older Chinese Americans. J Am Med Dir Assoc 2020; 22:344-348. [PMID: 32768374 DOI: 10.1016/j.jamda.2020.06.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the factors of advance directive (AD) completion among older Chinese Americans. DESIGN Cross-sectional survey. SETTING AND PARTICIPANTS Data came from 435 Chinese Americans aged 55 years and older living in 2 metropolitan areas through self-administered questionnaires and research assistant-administered interviews in 2018. Participants' average age was 75 years (standard deviation = 9.4). METHODS Logistic regression was used to examine factors associated with AD completion. RESULTS Approximately 14% of participants completed an AD. Older age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02-1.12], higher level of acculturation (OR 2.15, 95% CI 1.39-3.33), higher expectation for intergenerational support (OR 1.52, 95% CI 1.02-2.27), and having US citizenship (OR 3.02, 95% CI 1.26-7.23) were positively associated with AD completion. Physical and mental health needs were not significantly associated with AD completion. CONCLUSIONS AND IMPLICATIONS This study is among the first focusing on AD completion among Chinese Americans, one of the fastest-growing older minority populations in the United States. Findings highlight the influence of socioeconomic and cultural factors on AD completion and illustrate the importance of developing culturally sensitive interventions to promote end-of-life care decision making among older Chinese Americans.
Collapse
Affiliation(s)
- Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, CO.
| | - Yanqin Liu
- Hugh Downs School of Human Communication, Arizona State University, Tempe, AZ
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, MI
| | - Dexia Kong
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ
| | - Lin Jiang
- School of Social Work, The University of Texas Rio Grande Valley, Rio Grande Valley, TX
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY
| |
Collapse
|
21
|
Suk S, Kozachik SL, Cotter VT. Integrating Culturally Competent Advance Care Planning for Korean Immigrants: An Integrative Review. Am J Hosp Palliat Care 2020; 38:678-687. [PMID: 32551808 DOI: 10.1177/1049909120933856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS This review aims to explore the extant literature on the current utilization of ACP in Kisin order to obtain a comprehensive understanding of their health disparities and to determineevidence-based best practices to integrate culturally-competent ACP for EOL care of KIs. DESIGN A systematic integrative review of the literature Data Sources: Four electronic databases including PubMed, the Cumulative Index of Nursing and Allied Health Literature, the Cochrane Library, and Embase. METHOD The detailed search strategy for databases implicated a combination of MeSHkeywords and associated terms, which can be found in Table A.Results: Three themes emerged in relation to fundamental components in the integration of culturally-competent ACP for EOL of KIs: (1) cultural characteristics of KIs; (2) disparities in ethnic-oriented ACP and EOL care resources in KIs; and (3) KIs' perspectives on ACP. CONCLUSION The findings of this review indicate that culturally-competent ACP resources for KIsare presently quite insufficient. It is determined that much future research is needed on howculturally-competent ACP can best augment the quality of EOL care for KIs, and on howspecific interventions can effectively implement ACP in community settings. Impact: Such ongoing research dedicated to the development of feasible culturally competent practice guidelines is anticipated to markedly reduce health disparities and promote ACP in KIs. The recommendations in this review may support Korean primary HCPs, Korean health care center administrators, Korean health maintenance organizations (HMOs), Korean advance care nurse practitioners in hospice and palliative care, and nurse researchers in their work.
Collapse
Affiliation(s)
- Sojung Suk
- 1466Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Valerie T Cotter
- 1466Johns Hopkins University School of Nursing, Baltimore, MD, USA
| |
Collapse
|
22
|
Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124257. [PMID: 32549238 PMCID: PMC7345790 DOI: 10.3390/ijerph17124257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 12/02/2022]
Abstract
Deactivation of an implantable cardioverter-defibrillator (ICD) is a critical issue in the advance care planning (ACP) of ICD recipients; however, related perspectives have rarely been explored. Thus, this study aimed to provide an initial investigation of ICD recipients’ perceived susceptibility and barriers/benefits regarding ACP and/or advance directives (ADs), and associations of these modifiable factors with preferences for end-of-life life-sustaining treatments (LSTs) (cardiopulmonary resuscitation (CPR), ventilator support, hemodialysis, and hospice care). Using a descriptive correlational design, 48 ICD recipients (age, 50.1 years; male, 85.4%) completed survey questionnaires. “No burden on family” was the most highly valued (59.1%), followed by “comfortable death” (20.4%), and both (11.4%). LST preference was 43.8% for ventilator support, 45.8% for both hemodialysis and hospice care, and 54.2% for CPR. Perceived susceptibility to having unexpected end-of-life experiences increased the likelihood of preference for aggressive LSTs, with preferences increasing by 15% for CPR, 17% for ventilator support, and 23% for hemodialysis. A non-modifiable factor, older age, was the only predictor of increased preference for hospice care (odds ratio = 1.09, p = 0.016). Among the modifiable factors, a higher perceived susceptibility increased the likelihood of aggressive LST preferences. The findings imply that to facilitate informed decisions for LSTs, early ACP discussion could be helpful and enhance these modifiable factors.
Collapse
|
23
|
Yarnell CJ, Fu L, Bonares MJ, Nayfeh A, Fowler RA. Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada. CMAJ 2020; 192:E266-E274. [PMID: 32179535 PMCID: PMC7083548 DOI: 10.1503/cmaj.190655] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ethnicity may be associated with important aspects of end-of-life care, such as what treatments are received, access to palliative care and where people die. However, most studies have focused on end-of-life care of white, Hispanic and black patients. We sought to compare end-of-life care delivered to people of Chinese and South Asian ethnicity with that delivered to others from the general population, in Ontario, Canada. METHODS In this population-based cohort study, we included all people who died in Ontario, Canada, between Apr. 1, 2004, and Mar. 31, 2015. People were identified as having Chinese or South Asian ethnicity on the basis of a validated surname algorithm. We used modified Poisson regression analyses to assess location of death and care received in the last 6 months of life. RESULTS We analyzed 967 339 decedents, including 18 959 (2.0%) of Chinese and 11 406 (1.2%) of South Asian ethnicity. Chinese (13.6%) and South Asian (18.5%) decedents were more likely than decedents from the general population (10.1%) to die in the intensive care unit (ICU). The adjusted relative risk of dying in intensive care was 1.21 (95% confidence interval [CI] 1.15 to 1.27) for Chinese and 1.25 (95% CI 1.20 to 1.30) for South Asian decedents. In their last 6 months of life, decedents of Chinese and South Asian ethnicity experienced significantly more ICU admission, hospital admission, mechanical ventilation, dialysis, percutaneous feeding tube placement, tracheostomy and cardiopulmonary resuscitation than the general population. INTERPRETATION Decedents of Chinese and South Asian ethnicity in Ontario were more likely than decedents from the general population to receive aggressive care and to die in an ICU. These findings may be due to communication difficulties between patients and clinicians, differences in preferences about end-of-life care or differences in access to palliative care services.
Collapse
Affiliation(s)
- Christopher J Yarnell
- Interdepartmental Division of Critical Care Medicine (Yarnell, Fowler), Department of Medicine, University of Toronto; Mount Sinai Hospital (Yarnell); Institute of Health Policy, Management and Evaluation (Yarnell, Nayfeh, Fowler), University of Toronto; ICES (Fu); Division of Palliative Medicine (Bonares), Department of Medicine, University of Toronto; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont
| | - Longdi Fu
- Interdepartmental Division of Critical Care Medicine (Yarnell, Fowler), Department of Medicine, University of Toronto; Mount Sinai Hospital (Yarnell); Institute of Health Policy, Management and Evaluation (Yarnell, Nayfeh, Fowler), University of Toronto; ICES (Fu); Division of Palliative Medicine (Bonares), Department of Medicine, University of Toronto; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont
| | - Michael J Bonares
- Interdepartmental Division of Critical Care Medicine (Yarnell, Fowler), Department of Medicine, University of Toronto; Mount Sinai Hospital (Yarnell); Institute of Health Policy, Management and Evaluation (Yarnell, Nayfeh, Fowler), University of Toronto; ICES (Fu); Division of Palliative Medicine (Bonares), Department of Medicine, University of Toronto; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont
| | - Ayah Nayfeh
- Interdepartmental Division of Critical Care Medicine (Yarnell, Fowler), Department of Medicine, University of Toronto; Mount Sinai Hospital (Yarnell); Institute of Health Policy, Management and Evaluation (Yarnell, Nayfeh, Fowler), University of Toronto; ICES (Fu); Division of Palliative Medicine (Bonares), Department of Medicine, University of Toronto; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine (Yarnell, Fowler), Department of Medicine, University of Toronto; Mount Sinai Hospital (Yarnell); Institute of Health Policy, Management and Evaluation (Yarnell, Nayfeh, Fowler), University of Toronto; ICES (Fu); Division of Palliative Medicine (Bonares), Department of Medicine, University of Toronto; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.
| |
Collapse
|
24
|
Grace Yi EH. Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States. Innov Aging 2019; 3:igz012. [PMID: 31206041 PMCID: PMC6561643 DOI: 10.1093/geroni/igz012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Indexed: 01/05/2023] Open
Abstract
Background and Objectives Advance care planning (ACP) is a critical component of health care affecting the quality of later life. Responding to the increase in the older immigrant population in the United States, this empirical study explored the racial/ethnic gaps in ACP behaviors among older immigrants and examined the end-of-life (EOL) care planning and preferences of foreign-born immigrant older adults focusing on race/ethnicity, acculturation, health need factors, and enabling social factors (financial capability, public assistance, and informal supports) after controlling predisposing factors (sociodemographic characteristics). Research Design and Methods Using a subsample from the National Health and Aging Trends Study 2011 and 2012, hierarchical logistic regression models of the EOL plan and preferences were examined with 50 multiple imputation data sets (n = 232). Results Descriptive statistics reveal lower ACP engagement of immigrants from racial/ethnic minority groups. In logistic models, however, only Black immigrants were less likely than Whites to have EOL conversations. Among acculturation factors, age at immigration was only negatively associated with having a durable power of attorney for health, but not significantly associated with other ACP behaviors. Instead, health and social factors, primarily need in health and informal support (i.e., number of coresidents and receiving financial help from family members), were associated with different types of ACP components. Receiving public assistance (i.e., receiving Medicaid and SSI) were positively associated with EOL treatment preferences. Discussion and Implications Older foreign-born immigrants, in general, showed lower ACP engagement than the overall older population. Moreover, minority immigrants were lower on ACP engagement than both White immigrants. This study highlights the need for formal and informal assistance for enhancing EOL planning for older immigrants. Adding to the culturally competent approach, policy efforts should address social and health factors that accrued throughout individuals’ life spans and affect older immigrants’ EOL preparation and care.
Collapse
|
25
|
Attitudes and completion of advance care planning: Assessing the contribution of health beliefs about Alzheimer's disease among Israeli laypersons. Palliat Support Care 2019; 17:655-661. [DOI: 10.1017/s1478951519000336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivesThe purpose of this study was to assess laypersons’ attitudes and completion of advance care planning (ACP) and to examine associations with sociodemographic characteristics and health beliefs on Alzheimer's disease.MethodsA cross-sectional telephone survey was conducted during April and May 2017, with a sample of 514 Israeli adults, aged 18 years and above. A structured, pretested questionnaire assessing participants’ awareness, attitudes, and completion of ACP, as well as health beliefs on Alzheimer's disease (subjective knowledge, susceptibility, and worry), and sociodemographic factors, was used.ResultsTwo-fifths of the participants had heard of at least one of the terms: advance directives or durable power of attorney. Overall, participants expressed positive attitudes toward ACP. Results of regression models showed that gender, religiosity, and subjective knowledge of Alzheimer's disease were statistically significant correlates of attitudes toward ACP. Adding health beliefs on Alzheimer's disease doubled the amount of the variance explained, from 3% to 6%.Significance of resultsOur results support the use of cognitive models of health behavior by assessing intra-personal beliefs and knowledge to understand ACP attitudes and completion. Specifically, we demonstrated the importance of knowledge of Alzheimer's disease for ACP attitudes, suggesting the importance of including a module on the topic to ACP interventions.
Collapse
|
26
|
Rhee MK, Jang Y. Factors Associated With Designation of a Substitute Decision-Maker in Older Asian Americans: The Role of Cultural Factors. Int J Aging Hum Dev 2019; 91:21-36. [PMID: 31060362 DOI: 10.1177/0091415019848211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study examined the prevalence of and factors associated with the designation of a substitute decision-maker (SDM) in a sample of older Asian Americans. Particular emphasis was placed on cultural factors (ethnicity, time in the United States, English proficiency, acculturation, and cultural belief) that might influence on one's attitudes toward death and dying or end-of-life decision-making. Data were drawn from the 499 participants aged 60 years and older using the 2015 Asian American Quality of Life survey. Twenty-two percent of the sample had completed a legal document identifying a SDM. Results of a hierarchical logistic regression indicated that ethnicity, time in the United States, English proficiency, and acculturation were significant predictors. By examining the role of cultural factors in predicting SDM designation, the present study provided implications for culturally tailored strategies to help older Asian Americans plan their end-of-life care.
Collapse
Affiliation(s)
- Min-Kyoung Rhee
- 5116 USC Edward R. Roybal Institute on Aging, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Yuri Jang
- 5116 USC Edward R. Roybal Institute on Aging, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
27
|
Hong M, Casado BL, Lee SE. The Intention to Discuss Advance Care Planning in the Context of Alzheimer's Disease Among Korean Americans. THE GERONTOLOGIST 2019; 59:347-355. [PMID: 29385455 DOI: 10.1093/geront/gnx211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Advance care planning (ACP) is crucial for quality end-of-life care for patients with Alzheimer's disease. However, limited evidence is available about ACP among ethnic minorities, particularly in the context of Alzheimer's disease. The purpose of this study was to examine intention to discuss ACP for a family member with Alzheimer's disease among Korean Americans. Guided by the theory of planned behavior and prior research, we examined the relationships between acculturation, attitudes, subjective norms, perceived control, and intention to discuss ACP for a family member with Alzheimer's disease. RESEARCH DESIGN AND METHODS Path analyses were conducted on a cross-sectional convenience sample of 261 Korean Americans. Age, gender, education, and knowledge about Alzheimer's disease and ACP were included as covariates. RESULTS Our descriptive findings showed positive attitudes, strong subjective norms, and a high level of perceived control toward ACP discussion among the participants. The path analyses revealed that attitudes and subjective norms were positively related to intention for ACP discussion. Perceived control was not related to intention for ACP discussion. Among the covariates, greater knowledge about Alzheimer's disease was the only factor shown to be associated with the intention for ACP discussion. DISCUSSION AND IMPLICATIONS To promote ACP among this population, educational interventions designed to address positives attitudes and subjective norms toward ACP are suggested.
Collapse
Affiliation(s)
- Michin Hong
- School of Social Work, Indiana University, Indianapolis
| | | | - Sang E Lee
- School of Social Work, San Jose State University, California
| |
Collapse
|
28
|
Kim J, Heo S, Hong SW, Shim J, Lee J. Correlates of advance directive treatment preferences among community‐dwelling older people with chronic diseases. Int J Older People Nurs 2019; 14:e12229. [DOI: 10.1111/opn.12229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/09/2019] [Accepted: 02/01/2019] [Indexed: 01/23/2023]
Affiliation(s)
- JinShil Kim
- College of Nursing Gachon University Incheon South Korea
| | - Seongkum Heo
- College of Nursing University of Arkansas for Medical Sciences Little Rock Arkansas
| | - Sun Woo Hong
- Department of Emergency Medical Services Daejeon University Daejeon South Korea
| | - JaeLan Shim
- Department of Nursing, College of Medicine Dongguk University Gyeongsangbuk‐do South Korea
| | - Jung‐Ah Lee
- Sue and Bill Gross School of Nursing University of California Irvine, Irvine California
| |
Collapse
|
29
|
Detering KM, Buck K, Ruseckaite R, Kelly H, Sellars M, Sinclair C, Clayton JM, Nolte L. Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. BMJ Open 2019; 9:e025255. [PMID: 30647047 PMCID: PMC6340468 DOI: 10.1136/bmjopen-2018-025255] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES It is important that the outcomes of advance care planning (ACP) conversations are documented and available at the point of care. Advance care directives (ACDs) are a subset of ACP documentation and refer to structured documents that are completed and signed by competent adults. Other ACP documentation includes informal documentation by the person or on behalf of the person by someone else (eg, clinician, family). The primary objectives were to describe the prevalence and correlates of ACDs among Australians aged 65 and over accessing health and residential aged care services. The secondary aim was to describe the prevalence of other ACP documentation. DESIGN AND SETTING A prospective multicentre health record audit in general practices (n=13), hospitals (n=12) and residential aged care facilities (RACFs; n=26). PARTICIPANTS 503 people attending general practice, 574 people admitted to hospitals and 1208 people in RACFs. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of one or more ACDs; prevalence of other ACP documentation. RESULTS 29.8% of people had at least one ACD on file. The majority were non-statutory documents (20.9%). ACD prevalence was significantly higher in RACFs (47.7%) than hospitals (15.7%) and general practices (3.2%) (p<0.001), and varied across jurisdictions. Multivariate logistic regression showed that the odds of having an ACD were positively associated with greater functional impairment and being in an RACF or hospital compared with general practice. 21.6% of people had other ACP documentation. CONCLUSIONS In this study, 30% of people had ACDs accessible and a further 20% had other ACP documentation, suggesting that approximately half of participants had some form of ACP. Correlates of ACD completion were greater impairment and being in an RACF or hospital. Greater efforts to promote and standardise ACDs across jurisdictions may help to assist older people to navigate and complete ACDs and to receive care consistent with their preferences. TRIAL REGISTRATION NUMBER ACTRN12617000743369.
Collapse
Affiliation(s)
- Karen M Detering
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Kimberly Buck
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helana Kelly
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
| | - Marcus Sellars
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
| | - Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | - Josephine M Clayton
- Centre for Learning and Research in Palliative Care, Hammond Care, Greenwich Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Linda Nolte
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
30
|
Hong M, Yi EH, Johnson KJ, Adamek ME. Facilitators and Barriers for Advance Care Planning Among Ethnic and Racial Minorities in the U.S.: A Systematic Review of the Current Literature. J Immigr Minor Health 2019; 20:1277-1287. [PMID: 29124502 DOI: 10.1007/s10903-017-0670-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Growing evidence suggests a low engagement in advance care planning (ACP) among ethnic minorities in the U.S. The purpose of this study was to synthesize findings from prior research about ACP among ethnic minorities. An extensive literature search was conducted using multiple electronic databases. After applying inclusion criteria, 26 studies were included. Four categories of facilitators and barriers to ACP were identified: (1) Socio-demographic factors, (2) health status, literacy and experiences, (3) cultural values, and (4) spirituality. Socio-demographic factors showed inconsistent findings regarding their association with ACP engagement. Worse health status and knowledge about ACP are common facilitators across ethnic minority groups, whereas mistrust toward the health care system was a barrier only for Blacks. Collectivistic cultural values influenced ACP engagement among Latinos and Asian Americans; however, spirituality/religion played an important role among Blacks. The implications for culturally competent approaches to promote ACP and future research directions are discussed.
Collapse
Affiliation(s)
- Michin Hong
- Indiana University School of Social Work, 902 West New York Street, Indianapolis, IN, 46202, USA.
| | - Eun-Hye Yi
- Indiana University School of Social Work, 902 West New York Street, Indianapolis, IN, 46202, USA
| | - Kimberly J Johnson
- Indiana University School of Social Work, 902 West New York Street, Indianapolis, IN, 46202, USA
| | - Margaret E Adamek
- Indiana University School of Social Work, 902 West New York Street, Indianapolis, IN, 46202, USA
| |
Collapse
|
31
|
K Park HY, C Hendrix C. A literature review on end-of-life care among Korean Americans. Int J Palliat Nurs 2018; 24:452-461. [DOI: 10.12968/ijpn.2018.24.9.452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Cristina C Hendrix
- Associate Professor, Duke University, School of Nursing, Core Investigator, Durham Veterans Affairs Health Care System, Geriatric Research, Education and Clinical Center (GRECC)
| |
Collapse
|
32
|
Yarnell CJ, Fu L, Manuel D, Tanuseputro P, Stukel T, Pinto R, Scales DC, Laupacis A, Fowler RA. Association Between Immigrant Status and End-of-Life Care in Ontario, Canada. JAMA 2017; 318:1479-1488. [PMID: 28973088 PMCID: PMC5710367 DOI: 10.1001/jama.2017.14418] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE People who immigrate face unique health literacy, communication, and system navigation challenges, and they may have diverse preferences that influence end-of-life care. OBJECTIVE To examine end-of-life care provided to immigrants to Canada in the last 6 months of their life. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study (April 1, 2004, to March 31, 2015) included 967 013 decedents in Ontario, Canada, using validated linkages between health and immigration databases to identify immigrant (since 1985) and long-standing resident cohorts. EXPOSURES All decedents who immigrated to Canada between 1985 and 2015 were classified as recent immigrants, with subgroup analyses assessing the association of time since immigration, and region of birth, with end-of-life care. MAIN OUTCOMES AND MEASURES Location of death and intensity of care received in the last 6 months of life. Analysis included modified Poisson regression with generalized estimating equations, adjusting for age, sex, socioeconomic position, causes of death, urban and rural residence, and preexisting comorbidities. RESULTS Among 967 013 decedents of whom 47 514 (5%) immigrated since 1985, sex, socioeconomic status, urban (vs rural) residence, and causes of death were similar, while long-standing residents were older than immigrant decedents (median [interquartile range] age, 75 [58-84] vs 80 [68-87] years). Recent immigrant decedents were overall more likely to die in intensive care (15.6% vs 10.0%; difference, 5.6%; 95% CI, 5.2%-5.9%) after adjusting for differences in age, sex, income, geography, and cause of death (relative risk, 1.30; 95% CI, 1.27-1.32). In their last 6 months of life, recent immigrant decedents experienced more intensive care admissions (24.9% vs 19.2%; difference, 5.7%; 95% CI, 5.3%-6.1%), hospital admissions (72.1% vs 68.2%; difference, 3.9%; 95% CI, 3.5%-4.3%), mechanical ventilation (21.5% vs 13.6%; difference, 7.9%; 95% CI, 7.5%-8.3%), dialysis (5.5% vs 3.4%; difference, 2.1%; 95% CI, 1.9%-2.3%), percutaneous feeding tube placement (5.5% vs 3.0%; difference, 2.5%; 95% CI, 2.3%-2.8%), and tracheostomy (2.3% vs 1.1%; difference, 1.2%; 95% CI, 1.1%-1.4%). Relative risk of dying in intensive care for recent immigrants compared with long-standing residents varied according to recent immigrant region of birth from 0.84 (95% CI, 0.74-0.95) among those born in Northern and Western Europe to 1.96 (95% CI, 1.89-2.05) among those born in South Asia. CONCLUSIONS AND RELEVANCE Among decedents in Ontario, Canada, recent immigrants were significantly more likely to receive aggressive care and to die in an intensive care unit compared with other residents. Further research is needed to understand the mechanisms behind this association.
Collapse
Affiliation(s)
| | - Longdi Fu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Doug Manuel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | | | - Therese Stukel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ruxandra Pinto
- Programme in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Damon C. Scales
- University of Toronto Department of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Programme in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andreas Laupacis
- University of Toronto Department of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Programme in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Li Ka Shing Knowledge institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Robert A. Fowler
- University of Toronto Department of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
33
|
|
34
|
Jang Y, Park NS, Chiriboga DA, Radhakrishnan K, Kim MT. The Knowing–Doing Gap in Advance Directives in Asian Americans: The Role of Education and Acculturation. Am J Hosp Palliat Care 2016; 34:874-879. [DOI: 10.1177/1049909116668518] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: The purposes of the present study were (1) to explore the completion rate of advance directives (ADs) in a sample of Asian Americans and (2) to examine the direct and moderating effects of knowledge of AD, education, and acculturation in predicting AD completion. Education and acculturation were conceptualized as moderators in the link between knowledge and completion of ADs. Methods: Using data from 2609 participants in the 2015 Asian American Quality of Life survey (aged 18-98), logistic regression analyses on AD completion were conducted, testing both direct and moderating effects. Results: The overall AD completion rate in sample was about 12%. The AD knowledge and acculturation independently predicted AD completion. No direct effect of education was found; however, it interacted with AD knowledge. The AD knowledge was more likely to be translated into completion in the group with higher education. Conclusions: The AD completion rate observed in the present sample of Asian Americans was much lower than that of the US general population (26%-36%). The interactive role of education helps to explain the gap between AD knowledge and completion and suggests intervention strategies.
Collapse
Affiliation(s)
- Yuri Jang
- School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Nan Sook Park
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - David A. Chiriboga
- Department of Child and Family Studies, University of South Florida, Tampa, FL, USA
| | | | - Miyong T. Kim
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| |
Collapse
|