Three Papers Exploring Knowledge, Attitudes and Preferences About Hospice Care Among Chinese Americans

Racial disparities in hospice utilization have been a longstanding concern in the United States. Asian Americans are least likely among all racial and ethnic groups to receive hospice care. This phenomenon is understudied and has given rise to calls for: 1) research to understand the specific risk and protective factors relating to the underuse of hospice care; and 2) the development of culturally-appropriate interventions to increase hospice use in this population. This dissertation explores this topic in three papers, guided by the Behavioral Model of Health Service Use (BMHSU) model.The first paper examines the available evidence about hospice knowledge, attitudes, utilization, and the factors associated with these among Asian Americans, especially Chinese Americans, through a systematic review. The second and third papers use data from the Health Care Choices study, to explore this social issue among Chinese American older adults. Specifically, the aims of the second paper are to understand these older adults’ knowledge, attitudes, and preferences toward hospice use and associated factors. The third paper explores the attitudes and preferences toward hospice use among the adult children of Chinese American older adults and their knowledge of their parent’s preferences. The congruent and incongruent hospice attitudes and preference between the older parents and their adult children and the associated factors were explored through dyadic data analyses. Through identifying and understanding these factors and dynamics, these studies will inform healthcare providers and researchers to address the potential barriers and hopefully increase hospice care utilization among this population and reduce social inequities in hospice care.