UCSF

Older Chinese Americans often defer end-of-life (EOL) care discussions. Moreover,healthcare providers find facilitating EOL care discussions challenging, especially with patients whose ethnicities differ from their own. Currently, there is still little guidance on how to initiate and facilitate such discussions with older Chinese Americans and their families. In order to increase the engagement of older Chinese Americans, families and healthcare providers in EOL care discussions, this dissertation aims to (1) identify prevalence of EOL care discussions among Chinese and Chinese-American populations, (2) understand the facilitators and barriers related to EOL care discussions with older Chinese Americans and their families, (3) explore potential strategies to facilitate EOL care discussions with older Chinese Americans and their families.

To address the aims, an integrative literature review and a qualitative study that utilized focused ethnography were conducted. In the qualitative study, individual, semi-structured interviews were conducted with 14 community-dwelling older Chinese Americans, nine adult

children, and seven healthcare providers. The data were analyzed using thematic and constant comparative analysis.

The results of this dissertation suggest that Chinese-American populations experience similar facilitators and barriers to EOL care discussions as do Chinese populations who reside in other countries. Superstition, societal taboos related to death and dying and family objections were identified as the common barriers to EOL care discussions. However, older Chinese Americans and their adult children would discuss EOL care when the discussion was introduced at “optimal times,” which included after triggering events (e.g., death of loved ones, fall accidents), with changes in health status, or with advanced age. Older Chinese Americans, adult children and healthcare providers emphasized the importance of assessing readiness for EOL care discussions and they all recommended using indirect communication approaches.

In conclusion, assessing readiness to discuss EOL care should be an essential and necessary action to initiate end-of-life care

discussions with older Chinese Americans. Healthcare providers should proactively assess their patients’ readiness to discuss EOL care, and engage them in EOL care discussions during identified optimal times.