United States Acculturation and Cancer Patients' End-of-Life Care

Alexi A. Wright, Heather Stieglitz, Yankel M. Kupersztoch, M. Elizabeth Paulk, Yookyung Kim, Ingrid T. Katz, Francisco Munoz, Rachel B. Jimenez, Jan Mutchler, Lorna Rivera, Anthony L. Back, Holly G. Prigerson

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients' end-of-life treatment preferences and medical care. Methods and Findings: 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). Conclusion: 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).

Original languageEnglish (US)
Article numbere58663
JournalPLoS One
Volume8
Issue number3
DOIs
StatePublished - Mar 11 2013

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acculturation
Acculturation
Terminal Care
Chemotherapy
Health care
Education
Intensive care units
neoplasms
Oncology
Neoplasms
Health
health care workers
Caregivers
Communication
Patient Participation
Terminally Ill
Patient Preference
drug therapy
clinical trials
Clinical Trials

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Wright, A. A., Stieglitz, H., Kupersztoch, Y. M., Paulk, M. E., Kim, Y., Katz, I. T., ... Prigerson, H. G. (2013). United States Acculturation and Cancer Patients' End-of-Life Care. PLoS One, 8(3), [e58663]. https://doi.org/10.1371/journal.pone.0058663

United States Acculturation and Cancer Patients' End-of-Life Care. / Wright, Alexi A.; Stieglitz, Heather; Kupersztoch, Yankel M.; Paulk, M. Elizabeth; Kim, Yookyung; Katz, Ingrid T.; Munoz, Francisco; Jimenez, Rachel B.; Mutchler, Jan; Rivera, Lorna; Back, Anthony L.; Prigerson, Holly G.

In: PLoS One, Vol. 8, No. 3, e58663, 11.03.2013.

Research output: Contribution to journalArticle

Wright, AA, Stieglitz, H, Kupersztoch, YM, Paulk, ME, Kim, Y, Katz, IT, Munoz, F, Jimenez, RB, Mutchler, J, Rivera, L, Back, AL & Prigerson, HG 2013, 'United States Acculturation and Cancer Patients' End-of-Life Care', PLoS One, vol. 8, no. 3, e58663. https://doi.org/10.1371/journal.pone.0058663
Wright AA, Stieglitz H, Kupersztoch YM, Paulk ME, Kim Y, Katz IT et al. United States Acculturation and Cancer Patients' End-of-Life Care. PLoS One. 2013 Mar 11;8(3). e58663. https://doi.org/10.1371/journal.pone.0058663
Wright, Alexi A. ; Stieglitz, Heather ; Kupersztoch, Yankel M. ; Paulk, M. Elizabeth ; Kim, Yookyung ; Katz, Ingrid T. ; Munoz, Francisco ; Jimenez, Rachel B. ; Mutchler, Jan ; Rivera, Lorna ; Back, Anthony L. ; Prigerson, Holly G. / United States Acculturation and Cancer Patients' End-of-Life Care. In: PLoS One. 2013 ; Vol. 8, No. 3.
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title = "United States Acculturation and Cancer Patients' End-of-Life Care",
abstract = "Background: Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients' end-of-life treatment preferences and medical care. Methods and Findings: 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). Conclusion: 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).",
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AU - Stieglitz, Heather

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AU - Paulk, M. Elizabeth

AU - Kim, Yookyung

AU - Katz, Ingrid T.

AU - Munoz, Francisco

AU - Jimenez, Rachel B.

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AU - Back, Anthony L.

AU - Prigerson, Holly G.

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N2 - Background: Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients' end-of-life treatment preferences and medical care. Methods and Findings: 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). Conclusion: 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).

AB - Background: Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients' end-of-life treatment preferences and medical care. Methods and Findings: 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). Conclusion: 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).

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