Thesis (MGeront)--University of South Australia, 1999

Thesis (Ph. D.)--University of Sydney, 2008. / Title from title screen (viewed Jan. 19, 2009) Includes tables and questionnaires in English and Farsi. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Behavioural and Community Health Sciences, Faculty of Health Sciences. Includes bibliography. Also available in print form.

Thesis (MGeront)--University of South Australia, 1998

Thesis (B.A.(Hons.)) -- University of Adelaide, 1977. / Includes bibliographical references (p. 38-39).

Thesis (Ph.D.) -- University of Adelaide, Dept. of Clinical Nursing, 2000. / Bibliography: leaves 309-334.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2006. / Title from first page of PDF document. Includes bibliographical references (p. 30-31).

This study was designed to explore how Chinese families managed the care of an adult member with advanced cancer both in home and hospital settings, to identify factors that affected care management, to examine the influence of cultural beliefs and practices on caregiving, and to examine the preference for location of care, from the perspective of one family member. The method used in conducting this study was the grounded theory approach of qualitative research. Data were collected through a series of interviews with six Chinese informants (five adult children and one spouse). The initial interviews were guided by the research questions. Constant comparative analysis was employed throughout data collection to permit analytic material to guide and focus the process of constructing the core social process. The informants' degree of ethnic identity was measured using the Ethnic Identity Questionnaire to further validate the researcher's observations pertaining to cultural orientation. The results indicated that Chinese families managed the care of an adult member with advanced cancer through the balancing process. This process, used when patients were in hospital and home, characterized the struggle the families experienced in managing everchanging caregiving demands and everyday family demands. Balancing was comprised of four interrelated management strategies: gauging, anticipating, sharing the load, and resourcing. It was concluded that the process is not culturally-bound although activities of trying out and patterns of help-seeking were thought to be culturally based. Factors which were found to influence the balancing process were past experiences and the patients' and family members' style or previous patterns of coping. Cultural beliefs influenced family members' actions and the reasons given for their actions. The results also indicated that Chinese families preferred care at home to care in the hospital. However, care at home was contingent on four factors: availability and ability of caregivers, family support, information from physician, and patients' physical condition and symptom management. The hospital setting was identified as the place where the ill family would die. In terms of nursing practice, the results support the need for nurses to be family-focused and support the actions of family members as the families manage the care. The results also suggest nurses to explore their own beliefs as well as beliefs of patients and families to ensure sensitivity is shown to differences. The findings reinforce the importance of educating families, as well as other health care professionals, about nursing's role in providing care, especially in the community. With regard to nursing research, the results reinforce the need to conduct family unit research and further explore the validity of the balancing process with more Chinese families and other ethnic groups. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 47-51).

Chapter 1 presents the backgrounds and research questions of the dissertation project. Although everyone hopes to die with dignity, a “good death” is often privileged. Inequality in end-of-life care in the United States is striking; older minorities are 3 times more likely to receive intrusive care and experience hospital readmission and less likely to use hospice care and die at home. With the hope to address disparities in end-of-life outcomes, as part of the Affordable Care Act, Medicare expanded its benefit and started to reimburse end-of-life care planning services from 2016. This dissertation examines the roles of health insurance policy and its advocated intervention in ensuring person-centered dying experiences in the United States and the public readiness for establishing a similar end-of-life care policy in China. The second chapter examines whether physician–patient advance care planning (ACP) discussions, the “intervention” embedded in the policy, is effective at prompting end-of-life care planning behaviors and improving end-of-life experiences. I also studied the heterogenous effects by race and ethnicity. I used exit data about 7,282 deceased Medicare-eligible respondents from the Health and Retirement Study (HRS) from 2012 to 2020, a nationally representative biennial survey of U.S. older adults. I conducted latent class analysis to identify different end-of-life experiences and used multinomial logistic regression models to study the relationship between having ACP discussions with doctors and different end-of-life experiences in full and stratified samples by race and ethnicity. Then I used path analyses to test whether completing legal documentation initiated by ACP services explains the effectiveness of the intervention. The results show three types of end-of-life experiences among White, Black, and Hispanic older adults; significant effects of end-of-life care discussions with doctors on uncomfortable dying experiences and extensive use of invasive treatments in the older White population; and the partial mediating role of completion of legal health care documents on the relationship between ACP discussions and end-of-life outcomes. This study identified the limited effectiveness of physician–patient ACP discussions among minority older adults and emphasizes the importance of quality, content (e.g., to cover legal documentation during the conversation), and cultural appropriateness of ACP consultations led by doctors. The third chapter examines the heterogenous intent-to-treat effect of the Medicare policy on older adults’ motivation to plan for care by exploiting policy intervention as a natural experiment. Taking advantage of the longitudinal nature of the HRS, I used core data with 47,982 observations nested in 15,647 individuals across 9 years (2012–2020). I used two quasi-experimental models—interrupted time series analysis and difference-in-difference—to study the care-planning outcomes before and after the policy implementation between older adults eligible or not eligible for Medicare. I studied the heterogenous effects in stratified samples by race and ethnicity, immigration background, and socioeconomic status proxied by education and wealth. I used coarsened exact matching to address the potential bias of the comparison group not being the ideal counterfactual control unit. I found that in the total population, the Medicare policy was associated with a significant increase in the proportion of older adults who completed a living will and designated a durable power of attorney for health care, but not having an ACP conversation. Furthermore, although there were immediate positive policy effects, the increases in ACP outcomes driven by the ACA Medicare benefit expansion were not sustained. Finally, I found no evidence that the ACA Medicare benefit expansion was effective in improving the rates of ACP among Black, Hispanic, Asian, Native American, or non-U.S.-born older adults. I also identified heterogeneous policy effects by socioeconomic status. I discuss promising recommendations for health care policy and practice to improve the participation rate of end-of-life care planning. Chapter 4 explores the feasibility of encouraging physicians to discuss end-of-life care wishes with older patients in China. Knowledge of a medical diagnosis is critical for end-of-life decision making. However, a patient’s right to know their diagnosis is neither guaranteed nor protected by law in China. Doctors typically inform family members of the patient’s illness diagnosis and prognosis and let them decide whether to disclose this information to the patient. This study examined middle-aged and older Chinese adults’ preferences for disclosing their and significant others’ diagnoses and whether sociodemographic, economic, and cultural factors were associated with these preferences. The research team surveyed 571 adults aged 50 or older in Shanghai from 2021 to 2022. The outcome measures are preferences for diagnosis disclosures, including whether and to whom diagnoses should be disclosed. I characterized preference types using latent class analysis and estimated multinomial logistic regression to identify the covariates associated with each preference type. Three latent classes were identified. The transparent group (34%) believed patients, whether self or a significant other, should be informed of their diagnoses. The contradictory group (50%) held conflicting attitudes; they preferred to know their diagnosis but preferred that significant others not be informed of their diagnoses. The avoidant group (16%) preferred not to know their diagnosis or to disclose significant others’ diagnoses to them. Familism attitudes were positively associated with holding contradictory views. Experiences with hospitalization and medical decision-making for family members were associated with holding transparent views. I discuss the importance of illness disclosure for honoring patients’ autonomous decision-making.