Development and Formative Evaluation of a Death Education Program for Community-Dwelling Chinese Older Adults

Abstract Planning for end-of-life (EOL) care in advance can enhance one’s quality of life at EOL. Culturally sensitive educational programs are needed in Chinese populations to enlighten the public and encourage advance planning due to a culture of death-denying and avoidance. This study describes the team’s efforts to develop and formatively evaluate a death education program designed for community-dwelling Chinese older adults. The program was designed based on the Knowledge-Attitude-Behavior Model, as a 2-session 3-hour program spreading over two days with 1.5 hours for each day. The content paid attention to discussing the importance of making plans for EOL in Chinese culture and discussing how to have death-related conversations with the family and health care professionals. In 2020, semi-structured interviews were conducted by phone with 12 health care professionals and researchers, and four Chinese older adults in China to obtain their feedback on program content and delivery. The directed content analysis method was used to analyze the data. Although they confirmed multiple challenges in conducting death education in China, such as family avoidance even if an older adult initiates the death-related conversation, health care professionals not feeling comfortable with such discussions, etc., they also felt the urgency and importance of delivering death education among older adults and in society as a whole. Detailed suggestions were categorized into relationship building, program preparation (e.g., setting, materials), multiple ways of recruitment, target population, length, various formats of content delivery, content (e.g., pay attention to spiritual care), and general support from the public.


es

Seoul National University
SeoulSeoul-t'ukpyolsiRepublic of Korea

University of Sou
hern California
University of Southern California, Hangzhou, China (People's Republic), 2. University of Southern California
CaliforniaUnited States

Florida State University
TallahasseeFloridaUnited States

Lumarie Polivka-West 
Saint Louis University
Saint LouisMissouriUnited States

University of Georgia
AtlantaGeorgiaUnited States

Florida State University
Florida State University
FloridaUnited States

CLINICAL OUTCOMES OF HOME-BASED PALLIATIVE CARE: AN ADVANCE ILLNESS MANAGEMENT PROGRAM CULTURE DIFFERENCES IN ADVANCE CARE PLANNING AND IMPLICATIONS FOR SOCIAL WORK PRACTICE DEVELOPMENT AND FORMATIVE EVALUATION OF A DEATH EDUCATION PROGRAM FOR COMMUNITY- DWELLING CHINESE OLDER ADULTS Session 1075 (Paper) Health and Long-Term Care A COMPARATIVE ASSESSMENT OF LONG-TERM CARE FINANCING AND SERVICE DELIVERY MODELS

Innovation in Aging
5S1202120
Prior studies have reported evidence that patients with chronic medical conditions benefit from home-based palliative care to manage symptoms. The purpose of this study is to evaluate the efficacy of an advanced illness management program provided by a visiting nurse agency. This program aims to reduce the burden of illness and to manage symptoms of patients who have difficulty leaving their home due to severity of their medical conditions. Data for this study were collected from patients who received home-based palliative care from the agency. Although the program has enrolled close to 500 patients from 2016 to 2019, the analytic sample for this study was restricted to patients enrolled between 2018 -2019 who completed both baseline and follow-up assessments for three measures: Rapid Geriatric Assessment, Integrated Palliative Care Outcome Scale-Patien

Version (IPOS), and Brief Illness Perception Questionnaire (BIPQ; N=96, capturing 33.8% of eligible patients).
Paired sample t-tests were used to compare the symptoms and health outcomes between baseline and follow-u

assessments. Average age of the participants were 79.9 years. Results from the RGA measure showe
that patients' scores on frailty and sarcopenia were significantly lower at follow-up, indicating improvement. Comparison of scores between baseline and follow-up on the IPOS measure showed that patients experienced improvement in the following symptoms: pain, weakness, nausea, poor appetite, constipation, sore/dry mouth, drowsiness, and mobility. Findings suggest that palliative care services can effectively managed the symptoms and health outcomes of homebound chronically ill patients. Other implications include reduced emergency room visits and hospital admissions.

CULTURE DIFFERENCES IN ADVANCE CARE PLANNING AND IMPLICATIONS FOR SOCIAL WORK PRACTICE

Jung-Hwa Ha, 1 Changsook Lee, 1 and Jennifer Yoo, 2 1. Seoul National University,Seoul,Republic of Korea,2. University of Georgia,Atlanta,Georgia,United States Advance care planning (ACP) is the process of making plans and decisions regarding end-of-life care (EOLC) in advance while one has the physical and cognitive capacity to do so. However, even if health practitioners recognize the importance of ACP, they may be constrained by social and cultural factors in engaging their clients in ACP. This study examined cultural differences in ACP and various strategies that social workers use to initiate conversations on ACP in a range of settings. Using the case study method, we conducted in-depth interviews with 7 social workers who work in South Korea, 2 Korean-American social workers working in the Korean-American communities in the US, and 3 American social workers serving diverse populations in the US. Their practice sites include: university hospitals, day care centers, a community senior center, a nursing home, and a hospice agency.

CULTURE DIFFERENCES IN ADVANCE CARE PLANNING AND IMPLICATIONS FOR SOCIAL WORK PRACTICE
Jung-Hwa Ha, 1 Changsook Lee, 1 and Jennifer Yoo, 2 1. Seoul National University,Seoul,Republic of Korea,2. University of Georgia,Atlanta,Georgia,United States Advance care planning (ACP) is the process of making plans and decisions regarding end-of-life care (EOLC) in advance while one has the physical and cognitive capacity to do so. However, even if health practitioners recognize the importance of ACP, they may be constrained by social and cultural factors in engaging their clients in ACP. This study examined cultural differences in ACP and various strategies that social workers use to initiate conversations on ACP in a range of settings. Using the case study method, we conducted in-depth interviews with 7 social workers who work in South Korea, 2 Korean-American social workers working in the Korean-American communities in the US, and 3 American social workers serving diverse populations in the US. Their practice sites include: university hospitals, day care centers, a community senior center, a nursing home, and a hospice agency. Social workers in both countries emphasized the need to build rapport with their clients early on and to empower them to take the lead in their ACP while they were still healthy. In Korean and Korean-American communities, social workers recognized their clients' reluctance to speak about EOLC and highlighted the importance of communicating with their family due to their clients' preference for family-centered decision-making. When doing this, a stepby-step approach in giving relevant information was recommended. We identified relationship-building, empowerment, and culturally sensitive approaches as common strategies in initiating discussions on ACP in both countries. Planning for end-of-life (EOL) care in advance can enhance one's quality of life at EOL. Culturally sensitive educational programs are needed in Chinese populations to enlighten the public and encourage advance planning due to a culture of death-denying and avoidance. This study describes the team's efforts to develop and formatively evaluate a death education program designed for community-dwelling Chinese older adults. The program was designed based on the Knowledge-Attitude-Behavior Model, as a 2-session 3-hour program spreading over two days with 1.5 hours for each day. The content paid attention to discussing the importance of making plans for EOL in Chinese culture and discussing how to have death-related conversations with the family and health care professionals. In 2020, semi-structured interviews were conducted by phone with 12 health care professionals and researchers, and four Chinese older adults in China to obtain their feedback on program content and delivery. The directed content analysis method was used to analyze the data. Although they confirmed multiple challenges in conducting death education in China, such as family avoidance even if an older adult initiates the death-related conversation, health care professionals not feeling comfortable with such discussions, etc., they also felt the urgency and importance of delivering death education among older adults and in society as a whole. Detailed suggestions were categorized into relationship building, program preparation (e.g., setting, materials), multiple ways of recruitment, target population, length, various formats of content delivery, content (e.g., pay attention to spiritual care), and general support from the public.

cial workers in both
ountries emphasized the ne