Associations between United States acculturation and the end-of-life experience of caregivers of patients with advanced cancer

Susan DeSanto-Madeya, Matthew Nilsson, Elizabeth Trice Loggers, Elizabeth Paulk, Heather Stieglitz, Yankel M. Kupersztoch, Holly G. Prigerson

Research output: Contribution to journalArticle

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Abstract

Background: Cultural beliefs and values influence treatment preferences for and experiences with end-of-life (EOL) care among racial and ethnic groups. Within-group variations, however, may exist based on level of acculturation. Objectives: To examine the extent to which EOL treatment factors (EOL treatment preferences and physician-caregiver communication) and select psychosocial factors (mental health, complementary therapies, and internal and external social support) differ based on the level of acculturation of caregivers of patients with advanced cancer. Methods: One hundred sixty-seven primary caregivers of patients with advanced cancer were interviewed as part of the multisite, prospective Coping with Cancer Study. Results: Caregivers who were less acculturated were more positively predisposed to use of a feeding tube at EOL (odds ratio [OR] 0.99 [p = 0.05]), were more likely to perceive that they received too much information from their doctors (OR 0.95 [p = 0.05]), were less likely to use mental health services (OR 1.03 [p = 0.003] and OR 1.02 [p = 0.02]), and desire additional services (OR 1.03 [p = 0.10] to 1.05 [p = 0.009]) than their more acculturated counterparts. Additionally, caregivers who were less acculturated cared for patients who were less likely to report having a living will (OR 1.03 [p = 0.0003]) or durable power of attorney for health care (OR 1.02 [p = 0.007]) than more acculturated caregivers. Caregivers who were less acculturated felt their religious and spiritual needs were supported by both the community (β -0.28 [p = 0.0003]) and medical system (β -0.38 [p <0.0001]), had higher degrees of self-efficacy (β -0.22 [p = 0.005]), and had stronger family relationships and support (β -0.27 [p = 0.0004]). Conclusions: The level of acculturation of caregivers of patients with advanced cancer does contribute to differences in EOL preferences and EOL medical decision-making.

Original languageEnglish (US)
Pages (from-to)1143-1149
Number of pages7
JournalJournal of Palliative Medicine
Volume12
Issue number12
DOIs
StatePublished - Dec 1 2009

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Acculturation
Caregivers
Odds Ratio
Neoplasms
Living Wills
Advance Directives
Terminal Care
Family Relations
Mental Health Services
Enteral Nutrition
Self Efficacy
Complementary Therapies
Ethnic Groups
Social Support
Mental Health
Therapeutics
Communication
Psychology
Physicians

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine
  • Nursing(all)

Cite this

Associations between United States acculturation and the end-of-life experience of caregivers of patients with advanced cancer. / DeSanto-Madeya, Susan; Nilsson, Matthew; Loggers, Elizabeth Trice; Paulk, Elizabeth; Stieglitz, Heather; Kupersztoch, Yankel M.; Prigerson, Holly G.

In: Journal of Palliative Medicine, Vol. 12, No. 12, 01.12.2009, p. 1143-1149.

Research output: Contribution to journalArticle

DeSanto-Madeya, Susan ; Nilsson, Matthew ; Loggers, Elizabeth Trice ; Paulk, Elizabeth ; Stieglitz, Heather ; Kupersztoch, Yankel M. ; Prigerson, Holly G. / Associations between United States acculturation and the end-of-life experience of caregivers of patients with advanced cancer. In: Journal of Palliative Medicine. 2009 ; Vol. 12, No. 12. pp. 1143-1149.
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abstract = "Background: Cultural beliefs and values influence treatment preferences for and experiences with end-of-life (EOL) care among racial and ethnic groups. Within-group variations, however, may exist based on level of acculturation. Objectives: To examine the extent to which EOL treatment factors (EOL treatment preferences and physician-caregiver communication) and select psychosocial factors (mental health, complementary therapies, and internal and external social support) differ based on the level of acculturation of caregivers of patients with advanced cancer. Methods: One hundred sixty-seven primary caregivers of patients with advanced cancer were interviewed as part of the multisite, prospective Coping with Cancer Study. Results: Caregivers who were less acculturated were more positively predisposed to use of a feeding tube at EOL (odds ratio [OR] 0.99 [p = 0.05]), were more likely to perceive that they received too much information from their doctors (OR 0.95 [p = 0.05]), were less likely to use mental health services (OR 1.03 [p = 0.003] and OR 1.02 [p = 0.02]), and desire additional services (OR 1.03 [p = 0.10] to 1.05 [p = 0.009]) than their more acculturated counterparts. Additionally, caregivers who were less acculturated cared for patients who were less likely to report having a living will (OR 1.03 [p = 0.0003]) or durable power of attorney for health care (OR 1.02 [p = 0.007]) than more acculturated caregivers. Caregivers who were less acculturated felt their religious and spiritual needs were supported by both the community (β -0.28 [p = 0.0003]) and medical system (β -0.38 [p <0.0001]), had higher degrees of self-efficacy (β -0.22 [p = 0.005]), and had stronger family relationships and support (β -0.27 [p = 0.0004]). Conclusions: The level of acculturation of caregivers of patients with advanced cancer does contribute to differences in EOL preferences and EOL medical decision-making.",
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AU - DeSanto-Madeya, Susan

AU - Nilsson, Matthew

AU - Loggers, Elizabeth Trice

AU - Paulk, Elizabeth

AU - Stieglitz, Heather

AU - Kupersztoch, Yankel M.

AU - Prigerson, Holly G.

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N2 - Background: Cultural beliefs and values influence treatment preferences for and experiences with end-of-life (EOL) care among racial and ethnic groups. Within-group variations, however, may exist based on level of acculturation. Objectives: To examine the extent to which EOL treatment factors (EOL treatment preferences and physician-caregiver communication) and select psychosocial factors (mental health, complementary therapies, and internal and external social support) differ based on the level of acculturation of caregivers of patients with advanced cancer. Methods: One hundred sixty-seven primary caregivers of patients with advanced cancer were interviewed as part of the multisite, prospective Coping with Cancer Study. Results: Caregivers who were less acculturated were more positively predisposed to use of a feeding tube at EOL (odds ratio [OR] 0.99 [p = 0.05]), were more likely to perceive that they received too much information from their doctors (OR 0.95 [p = 0.05]), were less likely to use mental health services (OR 1.03 [p = 0.003] and OR 1.02 [p = 0.02]), and desire additional services (OR 1.03 [p = 0.10] to 1.05 [p = 0.009]) than their more acculturated counterparts. Additionally, caregivers who were less acculturated cared for patients who were less likely to report having a living will (OR 1.03 [p = 0.0003]) or durable power of attorney for health care (OR 1.02 [p = 0.007]) than more acculturated caregivers. Caregivers who were less acculturated felt their religious and spiritual needs were supported by both the community (β -0.28 [p = 0.0003]) and medical system (β -0.38 [p <0.0001]), had higher degrees of self-efficacy (β -0.22 [p = 0.005]), and had stronger family relationships and support (β -0.27 [p = 0.0004]). Conclusions: The level of acculturation of caregivers of patients with advanced cancer does contribute to differences in EOL preferences and EOL medical decision-making.

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