Examining the relationship between death attitude and AD completion and attitude among older Chinese Americans

项目摘要 提前指令（AD）的完成与提高临终（EOL）护理质量、减少使用 积极和昂贵的医疗，降低住院死亡的可能性，减少决策 医疗保健代理人的负担。老年华裔美国人，尽管是增长最快的， 美国最大的移民人口，有显着较低的AD完成率（10%-14%）， 美国老年人口（37%-60%）。虽然有一些研究调查了人口和 老年华裔美国人完成AD的文化因素，死亡态度，一种可改变的文化因素， 一个重要的因素，被忽视了。死亡态度与中国文化的许多方面密切相关， 例如孝道、家庭中心地位、家庭等级制度和宗教。此外，华裔美国人 认为讨论死亡会带来厄运，因此他们倾向于避免与死亡有关的话题， 谈话，这极大地阻碍了提前护理规划，并对老年人的福祉产生负面影响 华裔美国人和他们的家人。为了弥补这一知识差距，本项目将使用 解释性顺序混合方法设计，并侧重于以下具体目标：（目标1）确定因素， 也就是说，人口、社会和结构因素与华裔美国老人的死亡有关 目的2：探讨死亡态度与AD态度、AD完成率之间的关系 在年长的华裔美国人中;以及（目标3）评估如何以及以何种方式确定任何重要因素 目标2通过焦点小组影响华裔老年人的AD完成情况和对AD的态度。 以Andersen的卫生服务利用模型为指导，收集定量调查数据，并进行分析 目标1和目标2。然后，根据行为改变的跨理论模型，我们将 收集和分析焦点小组的定性数据，以实现目标3。调查结果将为未来的研究提供信息 制定、评估和实施文化上敏感的干预措施，以改善预先护理 计划和AD完成，并填补了专门针对提前护理计划需求的研究中的关键空白 在年长的华裔美国人中。

PROJECT ABSTRACT Advance directive (AD) completion is associated with improved quality of end-of-life (EOL) care, reduced use of aggressive and costly medical treatments, lower likelihood of in-hospital deaths, and lessened decisional burden of healthcare surrogates. Older Chinese Americans, despite being the fastest growing and the second largest immigrant population in the United States, have significantly lower AD completion rate (10%-14%) than the general older American population (37%-60%). Although a few studies have examined demographic and cultural factors of AD completion among older Chinese Americans, death attitude, a modifiable and culturally salient factor, has been overlooked. Death attitude closely intersects with many aspects of Chinese culture, such as filial piety, centrality of the family, familial hierarchy, and religion. Furthermore, Chinese Americans believe that discussing death brings bad luck and therefore they tend to avoid topics related to death in conversation, which greatly hinders advance care planning and negatively affects the well-being of older Chinese Americans and their family members. To address this knowledge gap, this project will use an explanatory sequential mixed-methods design and focus on the following specific aims: (Aim 1) identify factors, i.e., demographic, social, and structural factors, that are associated with older Chinese Americans’ death attitude; (Aim 2) examine the association between death attitude and attitude toward AD and AD completion among older Chinese Americans; and (Aim 3) evaluate how and in what ways any significant factors identified in Aim 2 influence older Chinese Americans’ AD completion and attitude toward AD through focus groups. Informed by the Andersen’s Health Service Utilization Model, we will collect and analyze quantitative survey data to address Aims 1 and 2. Then, informed by the Transtheoretical Model for Behavioral Change, we will collect and analyze qualitative data from focus groups to address Aim 3. Findings will inform future research on developing, evaluating, and implementing culturally responsive interventions that improve advance care planning and AD completion and fill critical gaps in research specifically to the advance care planning needs among older Chinese Americans.