The goal of this study is to obtain information which would allow us to design and implement better methods of obtaining advance care directives in ethnically diverse patient population. Much research has shown that there are social and cultural differences in the ways patients of different ethnicities view medical care, sickness, death and dying. We believe that understanding these differences may be crucial to the attempt to increase patient participation in decisions surrounding serious illness in multi-ethnic populations. Specifically, our hypothesis is that ethnicity may affect attitudes towards such advanced directives, with Korean Americans, Mexican Americans, and African Americans being less positively inclined toward such directives than Caucasians. Furthermore, we believe that much of the effect of ethnicity on attitudes towards such directives is mediated by demographic factors such as socioeconomic status, access to care, and religiosity which vary among ethnic groups; and by cultural norms which shape styles of decision making, and beliefs about the health care system. This study will measure attitudes towards advance directives in two phases. In phase One a questionnaire specifically designed to measure attitudes and variables which might influence those attitudes will be administered to 200 elderly persons from each of the four ethnic groups mentioned above. This questionnaire will measure dependent variables: attitudes towards advance directives, withholding and withdrawing care and decision-making preferences and other independent variables of interest, including socioeconomic status, health locus of control, religiosity, functional status and access to care. Stepwise multiple regression nd path analysis will be done to analyze the relationship between variables. In Phase Two in-depth interviews will be done by medical anthropologists on a subsample of the survey respondents (20 from each group) in order to capture qualitative information not obtained by the questionnaire and to put questionnaire findings in perspective.
