title: Knowledge of advance directive and perceptions of end-of-life care in Chinese-American elders: The role of acculturation.
abstract: OBJECTIVE
  This study aimed to describe knowledge of an advance directive (AD) and preferences regarding end-of-life (EoL) care communication, decision making, and designation of surrogates in Chinese-American elders and to examine the role of acculturation variables in AD awareness.
  
  
  METHODS
  Survey data were collected through face-to-face interviews on a sample of 385 Chinese-American elders aged 55 or above living in the Phoenix metropolitan area. The choice of language (Mandarin, Cantonese, or English) and place of interview (senior apartments, Chinese senior centers, or homes) was at the respondent's preference. Hierarchical logistic regression analysis was employed to examine the influence of acculturation variables on AD awareness.
  
  
  RESULTS
  Some 21% of participants had heard about ADs, and only 10% had completed one. Elders with higher acculturation levels (OR = 1.04, p < 0.10) and those residing more than 20 years in the United States (OR = 6.87, p < 0.01) were more likely to be aware of ADs after controlling for the effects of demographics, health, and experiences of EoL care. The majority preferred physicians to initiate AD discussions (84.9%) and identified burdens on families as the most important factor in making EoL decisions (89.3%). About 55.1 % considered daughters as the preferred healthcare surrogate.
  
  
  CONCLUSIONS
  Acculturation levels influence awareness of an AD, and family values are crucial in EoL care decision making. Cultural factors should be considered in designing and delivering appropriate programs to promote knowledge of EoL care among Chinese-American elders and their families.
authors.affiliation: School of Social Work,Arizona State University,Phoenix,Arizona.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
authors.affiliation: School of Social Work,Arizona State University,Phoenix,Arizona.
authors.forename: Fei
authors.initials: F
authors.lastname: Sun
authors.affiliation: School of Social Work,San Diego State University,San Diego,California.
authors.forename: Eunjeong
authors.initials: E
authors.lastname: Ko
authors.affiliation: School of Social Work,University of Wisconsin-Milwaukee,Milwaukee,Wisconsin.
authors.forename: Jung
authors.initials: J
authors.lastname: Kwak
authors.affiliation: School of Social Work,University of Missouri-St. Louis,St. Louis,Missouri.
authors.forename: Huei-Wern
authors.initials: HW
authors.lastname: Shen
mesh_terms: D000069:Acculturation; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010465:Perception; D013727:Terminal Care / Q000523:psychology*; D014481:United States
keywords: Acculturation; Advance directive; Chinese-American elders; End-of-life care