A SYSTEMATIC REVIEW OF END-OF-LIFE DECISION-MAKING IN CHINESE AMERICAN SENIORS
Background. According to the US Census Bureau (2012), the Asian population is projected to more than double from 2012 to 2050, with its share of the nation's total population climbing from 5.1% to 8.2%. As the largest subgroup of Asian Americans in the United States (US), Chinese Americans are an increasing portion of the aging US population. However, less than 2% of Asian American/Pacific Islanders (AAPI) use hospice care, despite AAPIs comprising 5% of the total US population. This disparity suggests our knowledge about the factors influencing CAS EOL decision-making is as yet incomplete.
Method. A literature search was conducted in September 2014 using CINAHL, PubMed, Medline, and Google Scholar databases and the Internet. Keywords used were: ‘Chinese American Seniors’, ‘Chinese Seniors’, ‘end-of-life’, ‘decision making’, ‘hospice care’, ‘palliative care’ and ‘aging’. No date restrictions were placed on articles considered for review, and national and international studies were included. Articles from peer-reviewed journals meeting the inclusion criteria included studies specific to CAS as well as Chinese seniors in westernized countries (i.e. Chinese seniors in Canada, Hong Kong, Singapore, and the United Kingdom). Articles with keywords and titles referencing Asian Americans without findings specific to the Chinese American subgroup were excluded. Analyses of the literature focused on references to cultural practices, acculturation, and EOL decision-making.
Results. The literature review revealed a dearth of information specific to CAS EOL care. Findings for factors influencing EOL decision-making were inconsistent. While some studies focused on the collectivistic nature of Chinese culture, others noted a shift towards Chinese seniors adopting Western values of patient autonomy. Many of the studies on Chinese seniors EOL care were conducted outside the US. Review of the literature suggested that for CAS, the EOL decision-making process is a complex interweaving of culture (Confucianism, filial piety), social/acculturation factors, and personal family dynamics. Most researchers did not measure the impact of acculturation factors (years education in the US, years of residence, work history, English proficiency, and living arrangements) on CAS EOL decision-making, but acculturation was referenced in explanations of CAS’ diverse EOL preferences. Most studies used convenience sampling and lacked generalizability.
Conclusion. As the population of Chinese American Seniors in the US increases, the importance of understanding CAS EOL decision-making increases as well. Continued research efforts should be made to elucidate CAS EOL decision-making process. Future studies need to measure acculturation as a possible source of diversity, which leads CAS to various outlooks on EOL care.
Implications. Culturally congruent EOL care for the CAS may not strictly adhere to traditional views of filial piety and family centered models. CAS are becoming increasingly diverse. Health care providers’ assessment of CAS’ degree of acculturation may provide insight into factors affecting EOL preferences.