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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.
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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.
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Pan CX, Luo EJ, Wang E, Szeto DA, Lum H, Ma J, Chen Stokes S, Chan S, Wong C, Guo J, Wang L, Chang V, Crupi RS. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Chinese American Patients. J Palliat Med 2023; 26:423-430. [PMID: 36260416 DOI: 10.1089/jpm.2022.0470] [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: 11/12/2022] Open
Abstract
The Chinese American population is one of the fastest-growing communities in the United States, composed of ∼5.4 million people, and represents ∼5.5% of overseas Chinese populations. With an expected exponential population rise, Chinese American patients who experience serious illness or approach end-of-life (EOL) may find their cultural values influencing the medical care they receive. Palliative care clinicians must recognize diverse cultural beliefs and preferences of Chinese American patients and their families. In this study, we provide 10 cultural pearls to guide the provision of palliative and EOL care for Chinese American patients, including discussions of Chinese traditions, communication strategies for Chinese patients and families, advance care planning, and EOL care beliefs.
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Affiliation(s)
- Cynthia X Pan
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Esther J Luo
- Outpatient Palliative Care, Supportive Care Services, Kaiser Permanente, Santa Clara, California, USA
| | - Eric Wang
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Deborah A Szeto
- Inpatient Palliative Care, Supportive Care Services, Kaiser Permanente, Santa Clara, California, USA
| | - Hillary Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jessica Ma
- Geriatric Research, Education, and Clinical Center, Durham VA Health System, Durham, North Carolina, USA.,Division of Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandy Chen Stokes
- Chinese American Coalition for Compassionate Care (CACCC), Shingle Springs, California, USA
| | - Sandy Chan
- Department of Palliative Medicine and Geriatrics, Stanford Health Care. Palo Alto, California, USA
| | - Christian Wong
- Department of Medicine, Albany Medical Center, Albany, New York, USA
| | - Jing Guo
- Division of Hospital Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Lifeng Wang
- Department of Pastoral Care and Education, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Victor Chang
- Section Hematology/Oncology, Medical Service, VA New Jersey Health Care System, East Orange, New Jersey, USA.,Division of Hematology Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark New Jersey, USA
| | - Robert S Crupi
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
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Sakai S, Nagae H, Miyashita M, Harasawa N, Iwasaki T, Katayama Y, Takenouchi S, Ikeda M, Ito M, Tamura K. Developing an Instrument to Assess the Readiness for Advance Care Planning. J Pain Symptom Manage 2022; 63:374-386. [PMID: 34756955 DOI: 10.1016/j.jpainsymman.2021.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022]
Abstract
CONTEXT In recent times, advance care planning for patients' end-of-life care preferences has attracted much attention worldwide. OBJECTIVES To develop the Readiness for Advance Care Planning (RACP) Scale. METHODS Participants included 624 Japanese citizens who were registered with a web-based survey company as of February 2019. Items regarding the process of advance care planning (ACP) were developed based on a literature review and expert panel discussions. The expert panel included nine experts and practitioners in the field of end-of-life care. Construct validity, concurrent validity, internal consistency, and test-retest reliability were evaluated. RESULTS Initially, 37 items were collected. Examination of the floor effect, item-total, good-poor analysis, and exploratory factor analysis yielded a five-factor model with 28 items. The goodness of fit of the model was GFI = 0.80, CFI = 0.91, and RMSEA = 0.08. The concurrent validity was statistically significant (rs = 0.26-0.45, ps < 0.001). Cronbach's alpha for the overall scale was 0.95. The corresponding values for the subscales ranged from 0.90 to 0.97. The intraclass correlation coefficients indicating test-retest reliability was 0.66 (P < 0.001) for the total scale and ranged from 0.52-0.65 for the five subscales. CONCLUSIONS The validity and reliability of the scale were generally acceptable. The RACP is an appropriate instrument to evaluate the level of readiness for ACP behaviors among people of various generations at every health stage. More studies are needed to examine the clinical utility of the RACP, both nationally and internationally.
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Affiliation(s)
- Shima Sakai
- School of Health Sciences (S.S.), Kyorin University, Tokyo, Japan.
| | - Hiroko Nagae
- School of Nursing (H.N., N.H., T.I), Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences (M.M.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nozomi Harasawa
- School of Nursing (H.N., N.H., T.I), Tokyo Women's Medical University, Tokyo, Japan
| | - Takako Iwasaki
- School of Nursing (H.N., N.H., T.I), Tokyo Women's Medical University, Tokyo, Japan
| | - Yoko Katayama
- Department of Nursing (Y.K.), Kagawa Prefectural University of Health Sciences, Kagawa, Japan
| | - Sayaka Takenouchi
- Department of Nursing Ethics, Division of Human Health Sciences, Graduate School of Medicine (S.T.), Kyoto University, Kyoto, Japan
| | - Mari Ikeda
- Department of Family Nursing, Graduate School of Medicine (M.I.),The University of Tokyo, Tokyo, Japan
| | - Mari Ito
- Nursing Department, Kawasaki Medical School General Medical Center (M.I.), Okayama, Japan
| | - Keiko Tamura
- Palliative Nursing, Department of Human Health Sciences, Graduate School of Medicine (K.T.), Kyoto University, Kyoto, Japan
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Wei FC, Hsu CK, Wu YL, Liao JY, Huang CH, Hsiung CA, Yu SJ, Lin CP, Chen PJ. Reliability and Validity of the Traditional Chinese Version of the Advance Care Planning Engagement Survey: A Pilot Evaluation in Taiwanese Outpatients. J Palliat Care 2021; 37:273-279. [PMID: 34787527 PMCID: PMC9344488 DOI: 10.1177/08258597211051208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The Advance Care Planning Engagement Survey (ACP-ES) has proven effective in evaluating individuals’ engagement in advance care planning (ACP). However, a Traditional Chinese version of ACP-ES (ACPES-TC) has not yet been developed. Therefore, this study aimed to translate and preliminarily validate the ACPES-TC in the Taiwanese context. Material and Methods: A forward and backward translation process was conducted. The translated questionnaire was confirmed by clinical and academic experts. The ACPES-TC was then evaluated for its reliability and validity with participants in the community and from an outpatient clinic in a medical center in Northern Taiwan. The participants comprised healthy people aged 20 to 30 years and patients ≥55 years old, recruited from September 17 to October 28, 2019. Results: Seventy people were recruited, including 20 people aged 20 to 30 years in the community and 50 patients ≥ 55 years old from clinics. The ACPES-TC scores are significantly higher among those of older age, having financial independence, and under long-term medication (p < .05). The patients’ preference for health-related decision-making is significantly correlated with the ACPES-TC score; the point-biserial correlation coefficient is 0.46 (p < .001). The discriminant and criterion-related validities are verified. The ACPES-TC demonstrated a good internal consistency (Cronbach's α .97), acceptable one-week test-retest reliability (overall intraclass correlation coefficient 0.86), and low practice effect between the test and retest (Cohen's d .43). Conclusion: The overall reliability and validity of the ACPES-TC are fair, which could be used to evaluate the patients’ engagement in ACP in Taiwan. However, further studies with a full-scale psychometric evaluation are needed.
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Affiliation(s)
- Fang-Chun Wei
- Department of Nursing, Cathay General Hospital, Taipei, Taiwan
| | - Chieh-Kuan Hsu
- Department of Nursing, Cathay General Hospital, Taipei, Taiwan
| | - Yu-Lin Wu
- Department of Nursing, St. Mary's Junior College of Medicine, Nursing and Management, Yilan, Taiwan
| | - Jung-Yu Liao
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Hsien Huang
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, Japan.,Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | | | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Ping-Jen Chen
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Exploring Differential Perceptions and Barriers to Advance Care Planning in Dementia among Asian Patient-Caregiver Dyads-A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137150. [PMID: 34281087 PMCID: PMC8297379 DOI: 10.3390/ijerph18137150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/17/2022]
Abstract
A parallel mixed-methods study on 20 patient–caregiver dyads in an Asian population was conducted to explore the differential perceptions and barriers to ACP in dementia. We recruited English-speaking patients with mild dementia and their caregivers. A trained ACP facilitator conducted ACP counseling. Patient–caregiver dyads completed pre–post surveys and participated in post-counseling qualitative interviews. We used mixed-methods analysis to corroborate the quantitative and qualitative data. Differential perceptions of ACP were reported among dyads, with caregivers less inclined for further ACP discussions. Post-ACP counseling, caregivers were significantly more likely to acknowledge barriers to ACP discussions than patients (57.9% versus 10.5%, p = 0.005). Thematic analysis of the interview transcripts revealed four themes around barriers to ACP: patient-related factors (transference of decision making, poor cognition and lack of understanding, and dis-inclination to plan for the future), caregiver-related factors (perceived negative impact on the patient, caregiver discomfort, and confidence in congruent decision making), socio-cultural factors (taboos, superstitions, and religious beliefs), and the inappropriate timing of discussions. In a collectivist Asian culture, socio-cultural factors pose important barriers, and a family-centric approach to initiation of ACP may be the first step towards engagement in the ACP process. For ACP in dementia to be effective for patients and caregivers, these discussions should be culturally tailored and address patient, caregiver, socio-cultural, and timing barriers.
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Yen CC, Lin CP, Su YT, Tsu CH, Chang LM, Sun ZJ, Lin BS, Wu JS. The Characteristics and Motivations of Taiwanese People toward Advance Care Planning in Outpatient Clinics at a Community Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062821. [PMID: 33802074 PMCID: PMC7999986 DOI: 10.3390/ijerph18062821] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
Advance care planning (ACP) provides access to complete advance decisions (ADs). Despite the legalization of ACP in Taiwan, it is underutilized in community settings. The objective of this study is to describe the service at a community hospital in Southern Taiwan. We retrospectively analyzed participants who were engaged in ACP consultations from January 2019 to January 2020. The characteristics, motivations, content, and satisfaction of participants are reported. Factors associated with refusing life-sustaining treatments (LST) or artificial nutrition/hydration (ANH) were analyzed using multivariate logistic regression. Of the 178 participants, 123 completed the ACP. The majority were female (64.2%), aged 61 on average and more than 80% had never signed a do-not-resuscitate order. In the ADs, most participants declined LST (97.2%) and ANH (96.6%). Family-related issues (48.9%) were the most prevalent motivations. Rural residence (OR 8.6, p = 0.005), increased age (OR 7.2, p = 0.025), and reluctance to consent to organ donation (OR 5.2, p = 0.042) correlated with refusing LST or ANH. Participants provided a positive feedback regarding overall satisfaction (good, 83%) compared to service charge (fair/poor, 53%). The study demonstrated high AD completion when refusing LST or ANH. These findings may facilitate the development of ACP as a community-based service.
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Affiliation(s)
- Chih-Chieh Yen
- Division of Hematology/Oncology, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan;
- Institute of Clinical Medicine, School of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Cheng-Pei Lin
- Institute of Community Health Care, School of Nursing, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Yu-Ting Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Chiu-Hua Tsu
- Department of Social Work, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan;
| | - Li-Mei Chang
- Department of Nursing, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan;
| | - Zih-Jie Sun
- Division of Family Medicine, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan; (Z.-J.S.); (B.-S.L.)
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Bing-Sheng Lin
- Division of Family Medicine, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan; (Z.-J.S.); (B.-S.L.)
| | - Jin-Shang Wu
- Division of Family Medicine, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan; (Z.-J.S.); (B.-S.L.)
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Correspondence:
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