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