2.50
Hdl Handle:
http://hdl.handle.net/10755/158029
Type:
Presentation
Title:
Exploring End-of-Life Decision Making Within Japanese-American Families
Abstract:
Exploring End-of-Life Decision Making Within Japanese-American Families
Conference Sponsor:Western Institute of Nursing
Conference Year:2006
Author:Colclough, Yoshi, PhD, RN
P.I. Institution Name:Montana State University
Title:Assistant Professor
Contact Address:294 Evening Star Lane, Bozeman, MT, 59715-2105, USA
Contact Telephone:406-994-6048
Purposes: To explore the experience of Japanese Americans (JAs) with end-of-life decision making for a recently deceased family member.
Background: The Patient Self-Determination Act (PSDA; 1990) is the primary legal basis for rights of individuals to make end-of-life care decisions. However, studies have identified barriers that arise from cultural differences in values, beliefs, and attitudes towards death and end-of-life care among related parties (Blackhall et al., 1999; Murphy et al., 1996; Orona, Koenig, & Davis, 1994). Given the rapidly aging JA population and their preference for a family-oriented decision-making model (Matsumura et al., 2002), increasing numbers of families face decisions about the use of life-sustaining treatments. Methods: Qualitative methods including a one-time, semi-structured interview were used to gather data from 16 JA family informants from a metropolitan area in the Northwest region of the U.S. With various demographic backgrounds, they described the experiences with the death of 22 family members. A grounded theory approach was used to identify a decision-making process model.
Results: A model of a process that included four dimensions of family understanding was developed. The four dimensions were: awareness of the seriousness of the family members' condition, decision-making about life-sustaining treatment, readiness for impending death, and experience of the dying process. Each reflected a continuum from low to high understanding. Aware of Seriousness of Condition included lack of awareness, awareness with recovery, and awareness with no recovery. Decision-Making Process involved a decisional phase with no discussion, implicit knowing, and explicit discussion and an executional phase with others, informants, and deceased family members. Readiness for Impending Death consisted of surprised, ambivalence, and ready. Experience of the Dying Process included regret, prolonged grief, unsolved questions, resolution, and acceptance. The model also reflected the influence of health care providers' involvement and generational differences, based on age cohort rather than immigration group, in adherence to traditional Japanese as well as Western values adapted through acculturation. The experience of most informants in making decisions within the context of the PSDA was not problematic. The majority reported completion of advance directives by their deceased family members even though these were seldom used in the actual decision-making process. Overall, JA families reported experiencing fewer feelings of burden/responsibility and less conflict within the family than has been reported in previous studies of primarily White Americans, reflective of cultural differences in the decision-making process Implications: The results suggest that nurses and other health care providers can impact the level of understanding within each of the dimensions in culturally sensitive ways and contribute to improving JA experience with end-of-life decision making. Assessment tools for patients, their family, and health care providers to prepare for a peaceful ending could be developed and tested for their utility. Then, designing and testing nursing interventions to promote awareness of the seriousness of the condition, preparedness for decision making, and preparedness for impending death of a family member could be followed.
Funding: Deans Dissertation Award and Sigma Theta Tau International, Beta Psi Chapter research award.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleExploring End-of-Life Decision Making Within Japanese-American Familiesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158029-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Exploring End-of-Life Decision Making Within Japanese-American Families</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Colclough, Yoshi, PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Montana State University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">294 Evening Star Lane, Bozeman, MT, 59715-2105, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">406-994-6048</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">yoshikoc@montana.edu</td></tr><tr><td colspan="2" class="item-abstract">Purposes: To explore the experience of Japanese Americans (JAs) with end-of-life decision making for a recently deceased family member.<br/>Background: The Patient Self-Determination Act (PSDA; 1990) is the primary legal basis for rights of individuals to make end-of-life care decisions. However, studies have identified barriers that arise from cultural differences in values, beliefs, and attitudes towards death and end-of-life care among related parties (Blackhall et al., 1999; Murphy et al., 1996; Orona, Koenig, &amp; Davis, 1994). Given the rapidly aging JA population and their preference for a family-oriented decision-making model (Matsumura et al., 2002), increasing numbers of families face decisions about the use of life-sustaining treatments. Methods: Qualitative methods including a one-time, semi-structured interview were used to gather data from 16 JA family informants from a metropolitan area in the Northwest region of the U.S. With various demographic backgrounds, they described the experiences with the death of 22 family members. A grounded theory approach was used to identify a decision-making process model.<br/>Results: A model of a process that included four dimensions of family understanding was developed. The four dimensions were: awareness of the seriousness of the family members' condition, decision-making about life-sustaining treatment, readiness for impending death, and experience of the dying process. Each reflected a continuum from low to high understanding. Aware of Seriousness of Condition included lack of awareness, awareness with recovery, and awareness with no recovery. Decision-Making Process involved a decisional phase with no discussion, implicit knowing, and explicit discussion and an executional phase with others, informants, and deceased family members. Readiness for Impending Death consisted of surprised, ambivalence, and ready. Experience of the Dying Process included regret, prolonged grief, unsolved questions, resolution, and acceptance. The model also reflected the influence of health care providers' involvement and generational differences, based on age cohort rather than immigration group, in adherence to traditional Japanese as well as Western values adapted through acculturation. The experience of most informants in making decisions within the context of the PSDA was not problematic. The majority reported completion of advance directives by their deceased family members even though these were seldom used in the actual decision-making process. Overall, JA families reported experiencing fewer feelings of burden/responsibility and less conflict within the family than has been reported in previous studies of primarily White Americans, reflective of cultural differences in the decision-making process Implications: The results suggest that nurses and other health care providers can impact the level of understanding within each of the dimensions in culturally sensitive ways and contribute to improving JA experience with end-of-life decision making. Assessment tools for patients, their family, and health care providers to prepare for a peaceful ending could be developed and tested for their utility. Then, designing and testing nursing interventions to promote awareness of the seriousness of the condition, preparedness for decision making, and preparedness for impending death of a family member could be followed.<br/>Funding: Deans Dissertation Award and Sigma Theta Tau International, Beta Psi Chapter research award.</td></tr></table>en_GB
dc.date.available2011-10-26T20:26:20Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:26:20Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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