“Collision of Eastern and Western Cultures”: A Qualitative Study on Changing Perceptions of End-of-Life Care Among Older Chinese Immigrants

Abstract

Introduction

Older Chinese immigrants have lower rates of end-of-life (EOL) care planning and use than non-Hispanic White counterparts, resulting in unmet palliative and hospice care needs. While acculturation is identified as a facilitator of end-of-life care planning, little is known about how perceptions shift throughout the acculturation process. Guided by the process model of acculturation, this qualitative study explored how perceptions of EOL care among older foreign-born Chinese immigrants changed during acculturation.

Methods

A qualitative descriptive design with language-matched focus groups was used. Thirty-one Chinese-speaking older immigrants satisfied eligibility criteria. Five focus groups were conducted in Mandarin (n = 3) and Cantonese (n = 2). Participants' mean age was 76.4 (SD = 6.3; range 63–86) with an average of 22.9 years in the U.S. (SD = 11.1).

Results

Using a thematic constant comparison approach combined with inductive coding, guided by the process model of acculturation, we revealed how participants' perceptions of EOL care evolved through the acculturation process at familial, institutional, and societal levels. Familial and social networks served as key sources of new information; encounters with healthcare and other institutions reshaped care preferences and decision-making; and broader cultural contexts facilitated deeper attitudinal shifts.

Conclusions

Participants reflected a dynamic interplay between exposure to U.S. healthcare, social network influences, and cultural or religious frameworks. Through this process, they developed new understandings of hospice and palliative care, reconciled these concepts with traditional values (e.g., filial piety), and gradually embraced more person-centered decision-making.