Study: Asian Americans Most Open to Receive Emotional Support Near End of Life, Less Likely to Have Advance Care Plan

Though older Asian-American adults may be less likely to discuss pain and symptom management needs with their health care professionals, they may be more receptive to the psychosocial support included in hospice and palliative care, according to recent research from VITAS’ Healthcare.

About 63% of Asians indicated that they would want to receive emotional support services at the end of life, according to VITAS Healthcare’s annual Advance Care Planning Report. This was more than any other ethnic group surveyed by the Chemed Corp. (NYSE: CHE) subsidiary this year.

Views on pain and discomfort at the end of life can differ among various demographics. Understanding these perspectives can drive conversations about management of these symptoms, according to VITAS Medical Director Robert Nguyen, who worked on the study.

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“For the older generations, suffering was also an often-accepted part of life,” Nguyen recently told local news. “There’s an expected level of stoicism as you are expected to bear a certain level of pain without ‘losing face’ or appearing weak.”

Asian communities are more likely to manage pain and other serious illness symptoms in the home with family members at the end of life, he added.

However, hospice can be one avenue for the kind of emotional support services that some older Asians seek as they approach this stage, Nguyen said.

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“Since death and dying involves the entire family, it can be challenging in America as families are losing cross-generational support due to work and other activities outside the home,” he said. “One thing to remember about hospice is that it won’t take away from any of these traditions, it’s about increasing quality of life and giving people the compassionate care that they want.”

The survey’s findings show that while Asian Americans may think about end-of-life matters, they aren’t discussing or documenting these plans with health care professionals. Nearly half (41%) of Asian Americans surveyed indicated that they knew the type of end-of-life care they wished to receive, but only 7% had documented these goals.

Additionally, only 14% of survey respondents indicated a preference to hold advance care planning conversations with a health care professional. However, about one-third of the individuals who identified as Asian American said that they were uncertain of where to turn for information about documenting their end-of-life wishes and values.

Conflicting cultural values and belief systems around the end of life may be a leading reason that Asian Americans are potentially less likely to have advance care planning conversations with a clinician or family member, according to Nguyen. Misconceptions about hospice and palliative care may also be fueling utilization disparities among this demographic.

The Asian population is the fastest growing racial or ethnic population in the United States relative to other demographics, having risen 29.3% between 2010 and 2019. By comparison, the African American and Hispanic populations grew 11.6% and 20%, respectively.

Nevertheless, hospice utilization among Asian populations remains low. They represent 1.8% of Medicare decedents who used hospice in 2018, the National Hospice and Palliative Care Organization (NHPCO) reported.

These data suggest that hospice and palliative care providers have more work to do to reach more diverse communities of color, according to Dr. Joseph Shega, VITAS’ executive vice president and chief medical officer.

More culturally diverse, and inclusive services are needed to improve access, awareness and understanding among communities of color, according to Shega. This begins with health care providers taking greater strides towards culturally competent care, he said.

“As health care professionals, it is our privilege and responsibility to initiate advance care planning conversations with our patients and guide them through the process,” Shega stated in an announcement statement last month. “For patients of color, having an advance directive in place can especially help to ensure an individual’s culture and traditions are respected and taken into account in their end-of-life care.”

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