College of Nursing & Health Sciences, University of Massachusetts-Boston, Boston, Massachusetts 02125, USA.
J Palliat Med. 2009 Dec;12(12):1143-9. doi: 10.1089/jpm.2009.0063.
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.
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.
One hundred sixty-seven primary caregivers of patients with advanced cancer were interviewed as part of the multisite, prospective Coping with Cancer Study.
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 (beta -0.28 [p = 0.0003]) and medical system (beta -0.38 [p < 0.0001]), had higher degrees of self-efficacy (beta -0.22 [p = 0.005]), and had stronger family relationships and support (beta -0.27 [p = 0.0004]).
The level of acculturation of caregivers of patients with advanced cancer does contribute to differences in EOL preferences and EOL medical decision-making.
文化信仰和价值观会影响不同种族和民族群体对临终关怀的治疗偏好和体验。然而，在同一群体中，根据文化适应程度的不同，可能会存在差异。
研究晚期癌症患者照顾者的临终治疗因素（临终治疗偏好和医生与照顾者的沟通）和选择的心理社会因素（心理健康、补充疗法以及内部和外部社会支持）在多大程度上因文化适应程度的不同而有所不同。
167 名晚期癌症患者的主要照顾者作为多站点前瞻性应对癌症研究的一部分接受了采访。
文化适应程度较低的照顾者更倾向于在临终时使用喂食管（比值比 [OR] 0.99 [p = 0.05]），更有可能认为他们从医生那里获得了过多的信息（OR 0.95 [p = 0.05]），不太可能使用心理健康服务（OR 1.03 [p = 0.003] 和 OR 1.02 [p = 0.02]），并且希望获得更多的服务（OR 1.03 [p = 0.10]至 1.05 [p = 0.009]），而不是他们的文化适应程度较高的对应者。此外，文化适应程度较低的照顾者照顾的患者不太可能报告拥有生前遗嘱（OR 1.03 [p = 0.0003]）或持久医疗授权书（OR 1.02 [p = 0.007]），而文化适应程度较高的照顾者照顾的患者则更有可能报告拥有这些文件。文化适应程度较低的照顾者感到他们的宗教和精神需求得到了社区（β-0.28 [p = 0.0003]）和医疗系统（β-0.38 [p < 0.0001]）的支持，自我效能感更高（β-0.22 [p = 0.005]），家庭关系和支持更强（β-0.27 [p = 0.0004]）。
晚期癌症患者照顾者的文化适应程度确实会导致临终治疗偏好和临终医疗决策的差异。
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