title: Associations between United States acculturation and the end-of-life experience of caregivers of patients with advanced cancer.
abstract: BACKGROUND
  Cultural beliefs and values influence treatment preferences for and experiences with end-of-life (EOL) care among racial and ethnic groups. Within-group variations, however, may exist based on level of acculturation.
  
  
  OBJECTIVE
  To examine the extent to which EOL treatment factors (EOL treatment preferences and physician-caregiver communication) and select psychosocial factors (mental health, complementary therapies, and internal and external social support) differ based on the level of acculturation of caregivers of patients with advanced cancer.
  
  
  METHODS
  One hundred sixty-seven primary caregivers of patients with advanced cancer were interviewed as part of the multisite, prospective Coping with Cancer Study.
  
  
  RESULTS
  Caregivers who were less acculturated were more positively predisposed to use of a feeding tube at EOL (odds ratio [OR] 0.99 [p = 0.05]), were more likely to perceive that they received too much information from their doctors (OR 0.95 [p = 0.05]), were less likely to use mental health services (OR 1.03 [p = 0.003] and OR 1.02 [p = 0.02]), and desire additional services (OR 1.03 [p = 0.10] to 1.05 [p = 0.009]) than their more acculturated counterparts. Additionally, caregivers who were less acculturated cared for patients who were less likely to report having a living will (OR 1.03 [p = 0.0003]) or durable power of attorney for health care (OR 1.02 [p = 0.007]) than more acculturated caregivers. Caregivers who were less acculturated felt their religious and spiritual needs were supported by both the community (beta -0.28 [p = 0.0003]) and medical system (beta -0.38 [p < 0.0001]), had higher degrees of self-efficacy (beta -0.22 [p = 0.005]), and had stronger family relationships and support (beta -0.27 [p = 0.0004]).
  
  
  CONCLUSIONS
  The level of acculturation of caregivers of patients with advanced cancer does contribute to differences in EOL preferences and EOL medical decision-making.
authors.affiliation: College of Nursing & Health Sciences, University of Massachusetts-Boston, Boston, Massachusetts 02125, USA. susan.desantomadeya@umb.edu
authors.forename: Susan
authors.initials: S
authors.lastname: DeSanto-Madeya
authors.forename: Matthew
authors.initials: M
authors.lastname: Nilsson
authors.forename: Elizabeth Trice
authors.initials: ET
authors.lastname: Loggers
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Paulk
authors.forename: Heather
authors.initials: H
authors.lastname: Stieglitz
authors.forename: Yankel M
authors.initials: YM
authors.lastname: Kupersztoch
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000069:Acculturation; D000223:Adaptation, Psychological; D001293:Attitude to Death / Q000208:ethnology*; D017028:Caregivers / Q000523:psychology*; D054521:Cultural Competency; D003657:Decision Making; D005195:Family Relations / Q000208:ethnology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011368:Professional-Family Relations; D020377:Self Efficacy; D012944:Social Support; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology*; D014481:United States