Knowledge About and Perceptions of Advance Care Planning and Communication of Chinese-American Older Adults
Knowledge About and Perceptions of Advance Care Planning and Communication of Chinese-American Older Adults
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DOI：
10.1111/jgs.14261
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发表时间：
2016-09-01
影响因子：
6.3
通讯作者：
Enguidanos, Susan
中科院分区：
文献类型：
--
作者：
Yonashiro-Cho, Jeanine;Cote, Sarah;Enguidanos, Susan
虽然提前护理计划（ACP）与临终时更好的护理、更好的死亡质量和幸存者更少的心理困扰有关，但ACP完成率的种族差异已被记录在案，这可能是由于缺乏对ACP的了解或文化价值观和偏好的差异。尽管亚裔美国人的数量迅速增加，但人们对华裔美国人的ACP偏好知之甚少。本研究的目的是探讨美国华裔老年人对ACP的知识、态度和偏好。焦点小组与中国老年人（n = 34）进行了普通话，广东话，英语和成绩单进行了分析，使用扎根理论的方法。确定的主题包括知识和经验与ACP和临终关怀的选择，健康作为一个因素，在ACP和通信的时间，和通信的临终关怀的喜好。知识和经验与ACP和寿命结束的决策不同，根据焦点小组，虽然很少有参与者有一个预先指示。研究结果表明，中国老年人更喜欢使用间接的沟通策略，如评论他人的情况，而不是直接陈述他们的愿望，和非正式的环境，如在家庭晚餐，而不是正式会议，向亲人传达他们的护理偏好，并可能在与临床医生沟通时采用类似的策略。鉴于医疗保险和医疗补助服务中心最近决定向参与提前护理计划对话的医生提供报销，这一点尤为重要。
Although advance care planning (ACP) is associated with better care at the end of life, better quality of death, and less psychological distress in survivors, ethnic disparities in ACP completion rates have been documented and may be attributable to lack of knowledge about ACP or differences in cultural values and preferences. Despite rapid increases in the size of the Asian-American population, little is known about ACP preferences of Chinese Americans. The purpose of this study is to explore the knowledge, attitudes, and preferences of older Chinese Americans toward ACP. Focus groups with Chinese older adults (n = 34) were conducted in Mandarin, Cantonese, and English, and transcripts were analyzed using a grounded theory approach. Identified themes included knowledge and experience with ACP and end-of-life care options, health as a factor in timing of ACP and communication, and communication of end-of-life care preferences. Knowledge of and experience with ACP and end-of-life decision-making varied according to focus group, although few participants had an advance directive. Findings suggest that Chinese older adults prefer to use indirect communication strategies, such as commenting on the circumstances of others rather than directly stating their wishes, and informal contexts, such as during a family dinner rather than formal meeting, to convey their care preferences to loved ones and may employ similar tactics when communicating with clinicians. This is particularly important given the recent decision by the Centers for Medicare and Medicaid Services to provide reimbursement to physicians for engaging in advance care planning conversations.