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Bringing Korean American Community Members Together for Advance Care Planning: Older Adults, Surrogate
Purpose Of Study:
To bring about positive behavioral changes-including greater self-efficacy, readiness, and contemplation of engaging in advance care planning-among Korean American older adults and their families who act as surrogate decision-makers and to increase the willingness of Korean American older adults to communicate end-of-life care preferences with potential surrogates and health care providers.
Primary Practice Setting:
Adult daycare center in Southeastern Pennsylvania.
Methodology And Sample:
The study used a one-group, quantitative survey design with preintervention and postintervention assessments. The sample consisted of Korean American older adults in an adult daycare center. Data collection measured behavioral changes among older adults and their families as future surrogate decision-makers regarding advance care planning, as well as the older adults' willingness to share end-of-life care preferences with family members and health care providers.
Results:
Ninety-one Korean American older adults and 24 surrogate decision-makers participated in the educational workshop. Following the workshop, both groups showed significant improvements in behavioral changes for advance care planning: Korean American older adults showed an average increase of 11.81 points ( p < .001) and surrogates 23.5 points ( p < .001). Among Korean American older adults, greater behavioral improvements were associated with willingness to share end-of-life care preferences with surrogates (OR = 1.24, p = .012) and to meet with health care providers (OR = 1.22, p < .001). Despite these improvements, only 27 of 91 Korean American older adults (29.67%) involved surrogates in the advance care planning process.
Implications For Case Management Practice:
This project, led by a nurse case manager, a registered nurse, and an advanced practice nurse clinician experienced in palliative and hospice community care, successfully encouraged Korean American older adults to become more aware of and prepared for advance care planning, as well as to discuss end-of-life care preferences with family members and health care providers. Although the initiative did not significantly increase meetings between older adults and their surrogates or providers, it did promote greater willingness to engage in end-of-life care discussions compared with previous studies. This approach is adaptable to other community settings and can be tailored to meet the linguistic and cultural needs of older adults with limited English proficiency in diverse ethnic groups.
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