Learning Objective #1: Understand Chinese-Americans' view of death, their attitudes and behavior toward using controversial life-sustaining treatments

Learning Objective #2: Apply a behavioral theory for evidence-based clinical practice in providing culturally competent EOL care

---

As the U.S. society becomes ethnically diverse and increasingly aged, this demographical change poses a challenge for health care professionals of all ethnic backgrounds. In the area of palliative care, since in the United States the concept of "End-of-life (EOL) treatment decision making" is Western oriented, it is unsurprising to discover that Chinese Americans, one of the largest American subpopulations, their EOL attitudes and preferences are distinct from legal standards set by and for European Americans.

Chinese Americans' EOL care is found compromised under this Euro-American health care context. However, there has been very limited research addressing this issue and previous studies were not theory-based, either. Given that underlying factors influencing the decision-making behavior have not been thoroughly explored, Chinese Americans' attitudes and preferences toward life-sustaining treatment (LST) such as cardiopulmonary resuscitation, mechanical ventilator, and tube feeding, remain unclear.

This on-going project has two foci: a) to explore traditional cultural factors that fundamentally shape Chinese Americans' view of death, and b) to apply a behavioral theory, Theory of Planned Behavior (TPB) (Ajzen, 1991) in charactering the behavior in question. Numerous cultural factors have been found, including Confucian ethics, family concept, collectivism, physician/male paternalism, filial piety, death taboo, and a Chinese view of good death. Together they explain why in general Chinese Americans are less in control, have reservations on discussing death, and favor LST. The TPB chosen from multiple health behavioral theories best characterizes the phenomena of our interest.

This project will expand the knowledge base of Chinese Americans' view of death and dying, and ultimately helps to improve Chinese Americans' quality of life at the EOL. Information provided here will also be helpful to non-Chinese-background health caregivers who have interests in providing cultural competent EOL care. There is a potential to alleviate health disparities of this specific cultural group.