Transcript Southeast Asian Women`s Attitudes Toward Completing Advance

Southeast Asian Women’s
Attitudes Toward Completing
Advance Directives
Lair Ky
California State University, Long Beach
May 2012
Introduction
Southeast Asians are the fastest growing minority population in the United
States, and are less likely to have completed advance directives or have
end-of-life discussions with their family members (Newman, Davidhizar, &
Fordham, 2006).
Since family caregiving in the Asian culture is often associated with being
female (Pinquart & Sorensen, 2005), the purpose of this study was to
specifically explore the attitudes of Southeast Asian women toward
completing advance directives and making end-of-life (EOL) care decisions
for their family members.
This study focused on two important research questions:
What are the cultural considerations and views of Southeast Asians
women in their knowledge and attitudes toward planning and
completing an advance directive (AD)?
How do Southeast Asian women perceive the impact of ADs on their
families?
Cross-Cultural Relevance
As the Southeast Asian population in Southern California continues to grow,
and as people get older, the need for EOL care discussions will become
more apparent.
The low completion rate of AD among ethnic minorities (Kwak & Haley,
2005), point to a need for social workers to actively reach out to ethnic
minority groups, from the stand point of this study, should focus on the
Southeast Asian population to help them understand why ADs are important
and highly encouraged among the U.S. health care system.
With knowledge and cultural sensitivity social workers will be more equipped
to better educate and assist this fast growing population of Southeast
Asians on ADs and the importance of completing them, so that their EOL
care wishes are known to their caregivers, families and their physicians.
Social Work Relevance
Social workers are well-known in working with culturally diverse individuals
and families (Congress, 2004).
Social workers facilitate communication about ADs to individuals and
families more frequently than physicians (Black, 2005).
If social workers expect to effectively assist the range of population they
work with in addressing EOL decision-making, they must adequately
understand ADs and demonstrate positive attitudes regarding discussing
and completing the documents (Baker, 2001).
Methods
An exploratory quantitative design was used to examine the attitudes and
perceived barriers in completing ADs and making EOL decisions among
Southeast Asian women.
The self- administered questionnaire consisted of two sections and a total of
26-items.
Section one consisted of a 10-item demographic questionnaire, developed
by the researcher.
Section two consisted of a 16-item, four-point Likert scale examining
attitudes toward ADs and EOL decisions, with four Advance Directive
Attitudes Survey (ADAS) subscales (a) opportunity for treatment, (b) impact
of AD on the family, (c) effect of AD on treatment, and (e) illness perception
developed by Nolan and Bruder (1997).
Methods (continued)
This study utilized three recruitment sources: (1) the Long Beach Friends
Church, (2) the Long Beach New Life Church of Nazarene and (3) the
snowball method, of people who may not necessarily attend the local
churches, for the non-randomized convenience sampling of 70 Southeast
Asian women.
The criteria for participation in the study include: females who were
Southeast Asian by heritage, were fluent in English, were between the ages
of 30 – 60, and who made health care decisions for their family members.
Data were analyzed using the Statistical Package for Social Sciences
(SPSS) program.
Descriptive and inferential tests including correlations, t-tests and one-way
ANOVA procedures were conducted to compare the respondents’
knowledge and attitude scales to each of the demographic items.
Results
Demographic Characteristics of Respondents (N = 70)
______________________________________________________________________________________________________________________________
Variable
N
%
______________________________________________________________________________________________________________________________
Ethnicity
Laotian
Cambodian
Filipino
Vietnamese
Marital Status
Married
Not Married
Education
High School Graduate or Less
Some College
College Graduate
Graduate Degree
Religion
Christian/Protestant
Buddhist
Catholic
Missing data
AD Knowledge
No
Yes
EOL Discussion with Family
No
Yes
Completed AD for Self
No
Yes
Completed AD for Family
No
Yes
22
18
16
14
31.4
25.7
22.9
20.0
52
18
74.3
25.7
20
14
22
14
28.6
20.0
31.4
20.0
31
22
16
1
44.3
31.4
22.9
1.4
30
40
42.9
57.1
47
23
67.1
32.9
65
5
92.9
7.1
62
8
88.6
11.4
______________________________________________________________________________________________________________________________
Results (continued)
Characteristics of the Subscales within the ADAS (N = 70)
Subscale
Possible Range
Observed
Range
M
SD
Reliability (α)
Opportunity for
Treatment
Choices
4-16
8-16
13.40
2.11
.86
Impact of ADs
on Family
8-32
18-32
24.47
3.34
.75
Effect of an AD
on Treatment
3-12
6-12
9.89
1.56
.80
Illness
Perception
1-4
1-4
2.66
.93
n/a
For research question one: What are the cultural considerations and views of Southeast Asians
women in their knowledge and attitudes toward planning and completing an advance directive (AD)?
The ADAS subscales on (a) opportunity for treatment choices, (c) effect of an AD on treatment and
(d) illness perception were examined. Overall, the respondents in this study are generally
knowledgeable about AD, and have a positive attitude towards AD, especially in the area of
opportunity for treatment choices, and effect of AD on treatment.
For research question two: How do Southeast Asian women perceive the impact of ADs on their
families? The ADAS subscale (b) impact of ADs on the family was examined. Sixty-three (90%) of
the respondents agreed that their family would want them to have and AD. Furthermore, 65 (92.8%)
of the respondents indicated that having an AD would keep their family from disagreeing over their
treatment if they were unable to speak for themselves.
Discussion
Surprisingly, the results from this study indicated that respondents who were Vietnamese, of
Catholic faith, who had a graduate degree, and who had completed an AD for themselves
scored consistently higher across all the ADAS subscales; suggesting that the respondents
had a positive attitude towards ADs.
The promising findings in this study echoed those of Douglas and Brown (2002) suggesting
that respondents who recognize the need for ADs, who are aware of the benefits of AD, and
who believe that ADs affect care positively at the end of life may be more apt to complete AD
documents.
The next steps for future research would be to include a larger study sample of the Southeast
Asian population, translate the survey into other languages, combine both quantitative and
qualitative study methods, and develop focus groups to help enhance EOL discussions
among these populations.
Since religion and spirituality are important aspects in EOL decisions, future research needs
to also incorporate aspects of religiosity and belief systems as these clearly impact the
individuals’ attitudes about AD and their usefulness.
It would also be beneficial for health care professionals to find creative and innovative ways
to provide education and interventions among the Southeast Asian population to help them
overcome the multitudes of barriers that can hinder them from completing an AD, and
ultimately enhance their quality in end-of-life care.
References
Baker, M. E. (2001). Knowledge and attitudes of health care social workers regarding
advance directives. Social Work in Health Care, 32(2), 61 -74. doi:10.1300/J010
v32n02_04
Black, K. (2005). Advance directive communication practices: Social workers’
contributions to the interdisciplinary heath care team. Social Work in Health
Care, 40(3), 39-55.
Congress, E. P. (2004). Cultural and ethical issues in working with culturally diverse
patients and their families: The use of the culturagram to promote cultural competent
practice in health care settings. Social Work in Health Care, 39(3/4), 249-262.
doi:10.1300/J010v39n03_03
Douglas, R., & Brown, H. (2002). Patients' attitudes toward advance directives. Journal
of Nursing Scholarship, 34(1), 61-65.
Kwak, J., & Haley, W. E. (2005). Current research findings on end-of-life decision making
among racially or ethnically diverse groups. Gerontologist, 45(5), 634-641.
Newman, J., Davidhizar, R. E., & Fordham, P. (2006). Multi-cultural and multi-ethnic
considerations and advanced directives: Developing cultural competency. Journal of
Cultural Diversity, 13(1), 3-9.
Nolan, M. T., & Bruder, M. (1997). Patients’ attitudes towards advance directives and end of
life treatment decisions. Nursing Outlook, 45(5), 204-208.
Pinquart, M., & Sörensen, S. (2005). Ethnic differences in stressors, resources, and
psychological outcomes of family caregiving: A meta-analysis. Gerontologist, 45(1),
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