Resilience in East Asian Immigrants for Advance Care Planning Discussions

Advance care planning (ACP) is a process to facilitate decision-making for future care and document values and preferences. However, the advance directive completion rates in East Asian Americans are low, which may extend to disparities in end-of-life care, including rates of hospice use and prevalence of unwanted aggressive treatments. To address this, this study uses information technology to develop a culturally tailored digital resilience-building intervention with and for East Asian immigrants to help them engage in ACP discussions. There are two aims of this study: (1) Conduct semi-structured interviews with a total of 30 religious leaders to identify the barriers and facilitators associated with discussing ACP and death-related topics with immigrants from China/Taiwan, Japan, and Korea and (2) Develop a culturally tailored digital resilience-building intervention using think-aloud interviews with 27 pairs of East Asian immigrants with cancer and their family caregivers (9 pairs each for immigrants from China/Taiwan, Japan, and Korea).

Inclusion criteria

for Religious Leaders:

• Age ≥ 18 years
• Serving as a chaplain or religious leader at a healthcare setting or religious organization
• Having experience providing pastoral or spiritual care to Chinese, Japanese, and Korean Americans in the US
• Being able to read and respond to questions in English, Mandarin, Cantonese, Japanese, or Korean.

Exclusion criteria

Not willing to provide consent.

Inclusion criteria

for Patients:

• Age ≥ 18 years
• Having a cancer diagnosis
• Likely self-identifying as a Chinese, Japanese, or Korean American/immigrant
• Being able to read and respond to questions in either English, Mandarin, Japanese, Korean, or Chinese dialects, such as Cantonese, Shanghai, Taishanese, or Taiwanese.

Exclusion criteria

for Patients:

• Having cognitive impairment per the Short Portable Mental Status Questionnaire with more than three errors

Inclusion criteria

for Family Caregivers:

• Age ≥ 18 years
• Being able to read and respond to questions in either English, Mandarin, Japanese, Korean, or Chinese dialects, such as Cantonese, Shanghai, Taishanese, or Taiwanese
• Having a family member who is likely to self-identify as a Chinese, Japanese, or Korean American/immigrant and has been diagnosed with cancer