Trust in Physicians and End-of-Life Discussions and Preferences for Place of Care Among US Chinese Older Adults

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2025-02-10 DOI:10.1111/jgs.19396

Hyosin Kim, Yanping Jiang, Paul R. Duberstein, Fengyan Tang, Elizabeth A. Luth

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Abstract

Background

Patient trust in physicians is essential for effective end-of-life discussions. Little is known about how Chinese older adults' trust in physicians relates to their end-of-life care discussions and care setting preferences.

Objective

To examine the association between medical trust among Chinese older adults and their views on end-of-life discussions and care setting preferences.

Design

Secondary analysis of longitudinal cohort data from the Population Study of Chinese Elderly (PINE) using linear mixed-effects logistic and multinomial logistic regressions, adjusting for covariates. Predicted probabilities of outcome measures were reported.

Participants

A total of 2192 Chinese older adult immigrants in greater Chicago participated in the PINE study from 2017 to 2020.

Main Measures

Outcome variables encompass four dimensions of end-of-life care planning: (1) beliefs about the importance of discussions with family; (2) discussions of end-of-life options with family; (3) preference for counseling with a healthcare provider as a resource; and (4) preferred place of care. The main independent variable was trust in physicians. Covariates included age, sex, education, income, years in the United States, living children, self-rated health, and medical conditions.

Key Results

Respondents with strong trust were less likely to consider end-of-life discussions with family important (AOR = 0.70, 95% CI: 0.55–0.88). Those with strong trust were more likely than those with weak trust to value counseling with a healthcare provider for end-of-life discussions with family (AOR = 5.86, 95% CI: 4.65–7.38). Moderate trust was associated with a preference for end-of-life care in a hospital (AOR = 1.63, 95% CI: 1.30–2.05) over home care, relative to weak trust.

Conclusions

Older Chinese immigrants with strong trust tended to place less emphasis on end-of-life discussions with family and favored one-on-one counseling with a healthcare provider for end-of-life discussion. Patient education and family engagement in end-of-life discussions led by trusted healthcare providers may be promising approaches to ensure goal-concordant care for this population.

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美国华人老年人对医生的信任和临终关怀讨论以及对护理场所的偏好。

背景：患者对医生的信任对于有效的临终讨论至关重要。关于中国老年人对医生的信任与他们的临终关怀讨论和护理环境偏好之间的关系，我们知之甚少。目的：研究中国老年人的医疗信任与他们对临终关怀和护理环境偏好的看法之间的关系。设计：对中国老年人人口研究（PINE）的纵向队列数据进行二次分析，采用线性混合效应logistic和多项logistic回归，调整协变量。报告预测结果测量的概率。参与者：2017年至2020年，大芝加哥地区共有2192名中国老年移民参加了PINE研究。主要测量方法：结果变量包括临终关怀计划的四个维度：(1)与家人讨论的重要性的信念；(2)与家人讨论临终选择；(3)倾向于向医疗保健提供者咨询作为一种资源；(4)首选护理地点。主要的自变量是对医生的信任。协变量包括年龄、性别、受教育程度、收入、在美国生活的年限、在世儿童、自评健康状况和医疗条件。关键结果：信任程度高的受访者不太可能认为与家人讨论临终问题很重要（AOR = 0.70, 95% CI: 0.55-0.88）。信任程度高的人比信任程度低的人更重视与医疗保健提供者进行临终讨论的咨询（AOR = 5.86, 95% CI: 4.65-7.38）。相对于弱信任，中等信任与更喜欢在医院进行临终关怀相关（AOR = 1.63, 95% CI: 1.30-2.05）。结论：具有较强信任的老年中国移民倾向于较少强调与家人讨论临终讨论，而倾向于与医疗保健提供者进行一对一的临终讨论。由值得信赖的医疗保健提供者领导的临终讨论中的患者教育和家庭参与可能是有希望的方法，以确保这一人群的目标一致的护理。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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