Culturally Appropriate Geriatric Care: Delivery of Care

Decision Making and Disclosure

Variation exists in decision making between different ethnic groups. One study revealed that as opposed to 91% of white patients, 83% of the frail older Asian patients expressed their own healthcare wishes. Asians were more likely to name a son as an alternate decision maker. (Hornung, 1998). Korean elders will often involve family members in decision making, and an important health decision will commonly involve their conferring with and relying on an eldest son, if one exists.

Attitudes regarding disclosure and consent are often conflicted in the Korean population. Some believe that voicing thoughts about death and illness will precipitate death and illness. Often Koreans believe that if the ill family member is told that they are ill or have a terminal diagnosis that they will lose the will to live or become depressed. Koreans often believe that only the family, and not the patient, should be told about a terminal diagnosis. In this family-centered model it is the sole responsibility of the family to hear bad news about the patient’s diagnosis and prognosis and to make the difficult decisions regarding goals of care. This approach toward decision making is used to protect the patient from bad news. Koreans are less likely to favor telling the truth about diagnosis and prognosis and are less likely to choose the patient as primary decision maker. Several prior studies regarding informing patients regarding the diagnosis of cancer with different ethnic groups have yielded similar results. (Eleazer, GP et.al., 1996). However this is often a source of conflict between the family and with the healthcare professionals who believe that the patient should be informed about the medical conditions. In these cases asking the patient what they would like to know about their condition would be important for disclosure and decision making.