Cross-cultural similarities and differences in attitudes about advance care planning

Henry S. Perkins, Cynthia M.A. Geppert, Adelita Gonzales, Josie D. Cortez, Helen P. Hazuda

Research output: Contribution to journalArticle

129 Scopus citations

Abstract

OBJECTIVE: Culture may have an important impact on a patient's decision whether to perform advance care planning. But the cultural attitudes influencing such decisions are poorly defined. This hypothesis-generating study begins to characterize those attitudes in 3 American ethnic cultures. DESIGN: Structured, open-ended interviews with blinded content analysis. SETTING: Two general medicine wards in San Antonio, Texas. PATIENTS: Purposive sampling of 26 Mexican-American, 18 Euro-American, and 14 African-American inpatients. MEASUREMENTS AND MAIN RESULTS: The 3 groups shared some views, potentially reflecting elements of an American core culture. For example, majorities of all groups believed "the patient deserves a say in treatment, " and "advance directives (ADs) improve the chances a patient's wishes will be followed." But the groups differed on other themes, likely reflecting specific ethnic cultures. For example, most Mexican Americans believed "the health system controls treatment, " trusted the system "to serve patients well, " believed ADs "help staff know or implement a patient's wishes, " and wanted "to die when treatment is futile." Few Euro Americans believed "the system controls treatment, " but most trusted the system "to serve patients well, " had particular wishes about life support, other care, and acceptable outcomes, and believed ADs "help staff know or implement a patient's wishes." Most African Americans believed "the health system controls treatment, " few trusted the system "to serve patients well, " and most believed they should "wait until very sick to express treatment wishes." CONCLUSION: While grounded in values that may compose part of American core culture, advance care planning may need tailoring to a patient's specific ethnic views.

Original languageEnglish (US)
Pages (from-to)48-57
Number of pages10
JournalJournal of General Internal Medicine
Volume17
Issue number1
DOIs
StatePublished - 2002

Keywords

  • Advance directives
  • Attitude toward death
  • Cross-cultural comparison
  • Culture
  • Terminal care

ASJC Scopus subject areas

  • Internal Medicine

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