The Relationship between Acculturation, Attitudes and Advance Care Planning by Iranian-Americans

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In spite of efforts to promote advance care planning (ACP) as well as legal cases highlighting the danger of not engaging in ACP there has been a marked under-utilization of ACP and decision-making instruments. To explore the reasons, this study set out to examine the relationship between and among acculturation, attitudes and ACP. Specifically, this study investigated how and to what extent acculturation levels influence attitudes toward and practices in ACP. The study utilized a cross-sectional and non-experimental design with participants completing a self-administered anonymous questionnaire. The data collection instrument was a questionnaire adapted from Kent (1996), and a modified version of Mendoza’s Cultural Life Styles Inventory, Version 2.0 (1994). One hundred ninety-eight (70%) respondents (N=282) reported having not prepared any advance care instructions. Only forty-eight women (32%) and thirty-six men (27%) in the sample reported as having engaged in ACP. Using chi-square test of independence, a very strong relationship was identified between the levels of acculturation and ACP, The relationship between religion and ACP was also determined as significant, Similarly, the relationship between education and levels of acculturation was demonstrated as significant, Logistic regression results revealed the culturally incorporated subjects ten timesand seven timesmore likely to engage in ACP than the culturally eclectic and culturally resistant population respectively. Analysis of the data demonstrated that while attitudes about ACP were generally positive, the attitude of an Iranian-American alone was not a significant factor in influencing ACP. On the other hand, the level of acculturation was determined to significantly influence ACP. In particular, Iranian-Americans who are culturally incorporated are more likely to engage in ACP than those who are culturally resistant and those who are culturally eclectic. The practical implications of this study for health care professionals include recognition and appreciation of the influence of culture and acculturation on ACP and end-of-life decision making. A better understanding of the factors that significantly influence ACP may improve how health professionals educate patients and engage them in meaningful discussions about the importance of ACP and end-of-life care. Analysis of the data demonstrated that while attitudes about advance care planning were generally positive, the attitude of an Iranian-American alone was not a significant factor in influencing advance care planning practices. On the other hand, the level of acculturation did prove to significantly influence advance care planning among Iranian-Americans. In particular, Iranian-Americans who are culturally incorporated (with a statistical tendency to be high on immersion in both the Iranian as well as American cultures) are more likely to engage in advance care planning than those who are culturally resistant (with a statistical tendency to be high on the Iranian culture) and those who are culturally eclectic. The practical implications of this study for health care professionals include recognition and appreciation of the influence of culture and acculturation on advance care planning and end-of-life decision making.