United states acculturation and cancer patients' end-of-life care. Academic Article Article uri icon

Overview

MeSH

  • Adult
  • Aged
  • Caregivers
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Patient Preference
  • Physician-Patient Relations
  • Prospective Studies
  • Reproducibility of Results
  • Risk Factors
  • Surveys and Questionnaires
  • United States

MeSH Major

  • Acculturation
  • Neoplasms
  • Terminal Care

abstract

  • Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients' end-of-life treatment preferences and medical care. In this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19-item scale developed to assess the degree of "Americanization" in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers' USAS scores predicted patients' communication, treatment preferences, and end-of-life medical care in multivariable models that corrected for significant confounding influences (e.g. education, country of origin, English proficiency). The USAS measure was internally consistent (Cronbach α = 0.98); and significantly associated with US birthplace (r = 0.66, P<0.0001). USAS scores were predictive of patients' preferences for prognostic information (AOR = 1.31, 95% CI:1.00-1.72), but not comfort asking physicians' questions about care (AOR 1.23, 95% CI:0.87-1.73). They predicted patients' preferences for feeding tubes (AOR = 0.68, 95% CI:0.49-0.99) and wish to avoid dying in an intensive care unit (AOR = 1.36, 95% CI:1.05-1.76). Scores indicating greater acculturation were also associated with increased odds of patient participation in clinical trials (AOR = 2.20, 95% CI:1.28-3.78), compared with lower USAS scores, and greater odds of patients receiving chemotherapy (AOR = 1.59, 95% CI:1.20-2.12). The USAS is a reliable and valid measure of "Americanization" associated with advanced cancer patients' end-of-life preferences and care. USAS scores indicating greater caregiver acculturation were associated with increased odds of patient participation in cancer treatment (chemotherapy, clinical trials) compared with lower scores. Future studies should examine the effects of acculturation on end-of-life care to identify patient and provider factors that explain these effects and targets for future interventions to improve care (e.g., by designing more culturally-competent health education materials).

publication date

  • 2013

has subject area

  • Acculturation
  • Adult
  • Aged
  • Caregivers
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Neoplasms
  • Patient Preference
  • Physician-Patient Relations
  • Prospective Studies
  • Reproducibility of Results
  • Risk Factors
  • Surveys and Questionnaires
  • Terminal Care
  • United States

Research

keywords

  • Journal Article
  • Multicenter Study

Identity

Language

  • eng

PubMed Central ID

  • PMC3594172

Digital Object Identifier (DOI)

  • 10.1371/journal.pone.0058663

PubMed ID

  • 23536809

Additional Document Info

start page

  • e58663

volume

  • 8

number

  • 3