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Trust in Physicians and End-of-Life Discussions and Preferences for Place of Care Among US Chinese Older Adults

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  • Background Patient trust in physicians is essential for effective end-of-life discussions. Little is known about how Chinese older adults' trust in physicians relates to their end-of-life care discussions and care setting preferences. Objective To examine the association between medical trust among Chinese older adults and their views on end-of-life discussions and care setting preferences. Design Secondary analysis of longitudinal cohort data from the Population Study of Chinese Elderly (PINE) using linear mixed-effects logistic and multinomial logistic regressions, adjusting for covariates. Predicted probabilities of outcome measures were reported. Participants A total of 2192 Chinese older adult immigrants in greater Chicago participated in the PINE study from 2017 to 2020. Main Measures Outcome variables encompass four dimensions of end-of-life care planning: (1) beliefs about the importance of discussions with family; (2) discussions of end-of-life options with family; (3) preference for counseling with a healthcare provider as a resource; and (4) preferred place of care. The main independent variable was trust in physicians. Covariates included age, sex, education, income, years in the United States, living children, self-rated health, and medical conditions. Key Results Respondents with strong trust were less likely to consider end-of-life discussions with family important (AOR = 0.70, 95% CI: 0.55–0.88). Those with strong trust were more likely than those with weak trust to value counseling with a healthcare provider for end-of-life discussions with family (AOR = 5.86, 95% CI: 4.65–7.38). Moderate trust was associated with a preference for end-of-life care in a hospital (AOR = 1.63, 95% CI: 1.30–2.05) over home care, relative to weak trust. Conclusions Older Chinese immigrants with strong trust tended to place less emphasis on end-of-life discussions with family and favored one-on-one counseling with a healthcare provider for end-of-life discussion. Patient education and family engagement in end-of-life discussions led by trusted healthcare providers may be promising approaches to ensure goal-concordant care for this population.
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  • The authors would like to thank Wendi Da, PhD for her invaluable assistance with data analysis. We also acknowledge the support of National Institute on Aging, which provided data access and analytic support (R01AG067548). Kim's effort was supported by the National Institute on Aging of the National Institutes of Health under award numbers R01AG066139 and R33AG068931.
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  • 1532-5415
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