Ethnic Diversity and Advanced Health-related Decisions
Our latest featured article it titles “Health-Related Decisions for Serious Illness Among Ethnically Diverse Older Adults” by Zahra Rahemi, PhD, RN; Christine Lisa Williams, DNSc, RN, PMHCNS; Ruth Marchand Tappen, EdD, RN, FAAN and Gabriella Anna Engstrom, PhD. The article is available for free download while it is featured, and we welcome your comments here! In this article, the authors discuss the evidence from their study that supports the great variability in individual situations at the end of life, and the importance of nursing care that remains responsive to each particular situation. Dr. Rahemi provided this background for ANS reviewers:
Universally, the population of older adults is dramatically growing. In the United States, culturally and ethnically diverse older adults are one of the fastest growing population. Cultural factors, including ethnicity, acculturation, and spirituality, have significant influence on diverse older adults and how and what they plan for their healthcare. Therefore, there is a need for multiple care options to avoid predetermined clinical practice guidelines for ethnically diverse older adults.
Cultural beliefs and value systems frequently prevent people from healthcare service use and healthcare decision making, which contribute to healthcare disparities for ethnically diverse older adults. In my current studies, I am interested in investigating factors that are pivotal for communication of decisions in advance. Innovative strategies to help individuals determine their goals of care are needed to clarify health-related decisions that ethnically diverse individuals may find challenging to articulate. Because ethnically diverse communities have strong family ties in general, the authors encourage informal and general discussions about goals of care among these communities. These conversations may ultimately inform significant others who are called upon to make decisions when older adults cannot. The new strategies recommended in this study may open new venues for professional development in nursing and ultimately promote culturally competent care.
In the field of ethnically diverse older adults and their healthcare decisions and preferences, the I started with a broad literature review and an integrative review that was published in ANS. Later, I continued my research in different ethnically diverse communities using different lenses, such as end-of-life preferences, health-related decisions for serious illness, and attitudes and behaviors regarding planning ahead for end-of-life care. I hope to introduce more innovative strategies to encourage ethnically diverse older adults to communicate their desired care choice when they are capable to communicate.
ANS: Advances in Nursing Science Blog 
You know, I’m embarrassed to admit that I haven’t given that much thought to how culture affects end of life decisions before. I’m glad you pointed out that quantity of life is a valid choice more commonly for some groups of people rather than quality. I also agree that advanced directive discussions need to occur as early as possible and not in a moment of crisis. I think back to a couple situations I’ve had with patients and I’m not sure they would make the same choice if they had time to really think through it. Thanks for the interesting article!