Faith, Family, Filiality, and Fate

What is the characterization of family involvement in health decisions, filial piety, religiosity/spirituality, and fatalism as they relate to attitudes/intentions toward end-of-life (EOL) planning/decision making among elderly Dominicans and Puerto Ricans in East Harlem, New York City?

An exploratory study using grounded theory and domain analysis was conducted with 51 elderly Dominicans and Puerto Ricans. Purposive and emerging themes were identified by three coders.

Purposive themes were family involvement in health decisions/filial piety and religiosity/spirituality/fatalism and for clinical EOL-related terms; emerging themes were accessing/using EOL care, autonomy, influence of death/dying on own future care decisions, and death/dying is a private matter.

The recommendations for community members are to empower awareness of EOL issues, engage providers regarding cultural needs, and clarification of advance care planning (ACP) function; the recommendations for providers are to engage patients to enhance culturally responsive care, clarify ACP function, and ask patients about preference for roles of family and God in decisions; the recommendations for policy makers are to enhance palliative education/access and immigration status research protections.