title: End-of-life preferences and presence of advance directives among ethnic populations with severe chronic cardiovascular illnesses.
abstract: BACKGROUND
  Little end-of-life planning occurs among ethnic minorities with severe cardiovascular illnesses.
  
  
  OBJECTIVE
  The purpose of this study was to explore end-of-life preferences and determine the presence of signed end-of-life advanced directives.
  
  
  METHODS
  Thirty ethnic minority patients volunteered for an open-ended question interview. Content analysis was used to summarize responses into themes using patients' terms.
  
  
  RESULTS
  Five themes emerged: (a) importance of family involvement in care at end of life; (b) being pain free (or pain controlled) at the end of life; (c) having a comfortable environment for death was desired; (d) wanting no procedures for prolonging life; and (e) desiring a relationship with a professional for end-of-life decision making (reported as inconsistently available). New unique findings were related to concerns about multiple and repeatedly rotating professionals not allowing these ethnic patients end-of-life discussions and fear that signing forms would lead to deportation. Overall, 50% of the participants had signed standard advanced directives as requested upon entry to the home care agency.
  
  
  CONCLUSIONS
  Most of these very ill patients did readily discuss these sensitive issues with the research nurse. Cardiovascular training in end-of-life care should include sensitivity to ethnic and cultural preferences and competencies in interviewing on sensitive topics.
authors.affiliation: School of Nursing, University of Kansas, USA.
authors.forename: Ubolrat
authors.initials: U
authors.lastname: Piamjariyakul
authors.forename: Sarah
authors.initials: S
authors.lastname: Myers
authors.forename: Marilyn
authors.initials: M
authors.lastname: Werkowitch
authors.forename: Carol E
authors.initials: CE
authors.lastname: Smith
mesh_terms: D016223:Advance Directives / Q000208:ethnology* / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000523:psychology; D002908:Chronic Disease; D054521:Cultural Competency; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006738:Hospices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology; D057240:Patient Preference / Q000208:ethnology* / Q000523:psychology; D013727:Terminal Care / Q000523:psychology*; D014481:United States
keywords: End-of-life care preferences; cardiovascular illnesses; ethnic minority; palliative care preferences