Collective Bargaining: Tour of East and South Asian Cultural Medical Decision Making

Outcomes

1. Participants will self-report the ability to identify considerations that shape medical decision-making preferences for East and South Asian families (e.g., roles of patients and families, attitudes towards clinicians, religious/spiritual influences, and community organizations).

2. Participants will apply a framework based on cultural humility while navigating shared decision making with their ESA patients and families.

Key Message

As Asian American communities grow in the U.S., clinicians will increasingly care for diverse families affected by serious illness, who may not consider patient autonomy as the consummate value. This interdisciplinary panel will use clinical vignettes to model a systematic approach for identifying factors that influence decision-making preferences when caring for East and South Asian families facing serious illness.

Abstract

The National Institute of Health's Minority Health and Health Disparities Research Framework highlights a key social determinant of health being medical decision-making (MDM) (1). This can be challenging when palliative care clinicians care for patients whose MDM at end-of-life is culturally discordant (2-5). One such patient population is the diverse and fast growing Asian American (AA) population (6). As clinicians support AA families, they may feel unprepared to reconcile families’ cultural preferences for collective MDM with the American healthcare system's orientation towards autonomous MDM (3).

Objectives

Using a case-based approach, an interdisciplinary panel, consisting of clinicians and caregivers, will use the ABCDE Cultural Assessment Model (7) to equip clinicians in uncovering factors that impact MDM in East and South Asians grappling with serious illness. Factors may include roles of patients and families, attitudes towards clinicians, religious/spiritual considerations, and community resources. This session will help clinicians compare and contrast MDM nuances amongst East and South Asian cultures, ultimately improving clinician-patient interaction skills, enhancing cultural humility, and reducing healthcare disparities.

Conclusion

Palliative care clinicians will apply an evidence-based model of cultural humility to real-world scenarios of collective MDM, to improve care for Asian families affected by serious illness and reduce healthcare disparities.

References

1. Alvidrez J, Castille D, Laude-Sharp M, Rosario A, Tabor D. The National Institute on Minority Health and Health Disparities Research Framework. Am J Public Health. 2019 Jan;109(S1):S16-S20. 2. Madni A. Culturally Responsive Care for Patients With a Serious Illness. Journal of Palliative Medicine 2024 27:5, 699-701 3. Jia Z, Leiter RE, Sanders JJ, et al. Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Ventilation When Hospitalized at the End-of-Life. J Gen Intern Med. 2022;37(4):737-744. 4. Patel, RV, Bowden, JM, Boselli, D, et al. The influence of religion/spirituality (R/S) on end of life (EOL) outcomes among patients of Dharmic religions with cancer: A mixed methods study. JCO Oncology Practice 2023 19:11_suppl, 230-230 5. Pan CX, Luo EJ, Wang E, et al. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Chinese American Patients. J Palliat Med. 2023;26(3):423-430. doi:10.1089/jpm.2022.0470 6. Pew Research Center. (April 9, 2021). Asian Americans are the fastest-growing racial or ethnic group in the U.S. https://www.pewresearch.org/short-reads/2021/04/09/asian-americans-are-the-fastest-growing-racial-or-ethnic-group-in-the-u-s/ 7. Cain CL, Surbone A, Elk R, Kagawa-Singer M. Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision Making. J Pain Symptom Manage. 2018 May;55(5):1408-1419.