Ibrao Miquela, Burrage Rachel, Muneoka Shelley, Kawakami Keilyn L, Tanji Tarin T, Tanoue Leslie, Braun Kathryn L
Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.
Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.
J Palliat Med. 2025 Apr;28(4):476-483. doi: 10.1089/jpm.2024.0332. Epub 2024 Dec 12.
Formal assessment of What Matters in end-of-life care is often done in medical settings through legal forms. Past research indicates that Native Hawaiians are less likely to complete these forms than Whites. The purpose of this study was to explore health care preferences among Native Hawaiian elders and to identify cultural themes that may impact quality care at end of life. To explore What Matters to Native Hawaiian elders, as culture likely impacts health care and end-of-life preferences. A secondary analysis of qualitative data collected through a multiyear interview project in Hawai'i. Twenty participants age 60+ living in rural Hawai'i. Deductive coding was informed by guidelines on What Matters according to the Institute of Healthcare Improvement's 4Ms Framework. Inductive coding identified themes specific to Native Hawaiian elders as part of their culture. Themes suggest the criticality of: (1) incorporating cultural traditions into health care routines; (2) involving family in health and end-of-life decisions; (3) supporting home-based care at the end of life; and (4) building strong patient-provider relationships. Although findings parallel preferences expressed in other populations, the data provide additional insights into the preferences of Native Hawaiian elders anticipating end-of-life care. Recommendations for culturally competent care include: (1) develop relationships with Native Hawaiian patients well before end-of-life care is needed to facilitate discussions of care preferences; (2) work collaboratively with the patient and the patient's defined family; (3) ask about cultural practices and engage traditional healers as directed by the patient; and (4) provide services in patients' homes and communities.
对临终关怀中重要事项的正式评估通常在医疗环境中通过法律表格进行。过去的研究表明，夏威夷原住民比白人更不太可能填写这些表格。本研究的目的是探讨夏威夷原住民老年人的医疗保健偏好，并确定可能影响临终优质护理的文化主题。为了探究对夏威夷原住民老年人来说重要的事项，因为文化可能会影响医疗保健和临终偏好。对通过夏威夷一项为期多年的访谈项目收集的定性数据进行二次分析。20名年龄在60岁及以上、居住在夏威夷农村的参与者。演绎编码依据医疗改进研究所4M框架中关于重要事项的指导方针进行。归纳编码确定了作为夏威夷原住民老年人文化一部分的特定主题。这些主题表明了以下几点的重要性：(1) 将文化传统融入医疗保健常规；(2) 让家人参与医疗和临终决策；(3) 在临终时支持居家护理；(4) 建立牢固的医患关系。尽管研究结果与其他人群表达的偏好相似，但这些数据为预期临终护理的夏威夷原住民老年人的偏好提供了更多见解。针对具有文化胜任力护理的建议包括：(1) 在需要临终护理之前很久就与夏威夷原住民患者建立关系，以便于讨论护理偏好；(2) 与患者及其指定的家人合作；(3) 询问文化习俗，并按照患者的指示邀请传统治疗师；(4) 在患者家中和社区提供服务。
