Perceptions of Asian Indian-Americans on Completing Advance Directives

Objective: To assess the impact of race and ethnicity on completion of advance directives among Asian Indians immigrants. Background: Currently, almost 85% of Americans die in a healthcare setting. Advance directives indicate an individual's healthcare preferences and/or a specific individual to speak on their behalf in the event that they are incapacitated. Traditionally, Indian culture also does not allow for open discussion of death and dying. Methods: Inclusion criteria for this study required participants to be of Asian Indian descent and to be between the ages of 40 and 64. Three focus groups were conducted to assess participants' knowledge and opinions regarding advance directives. A survey was also distributed to all participants prior to the focus group. Focus group transcripts were analyzed for content patterns, using the ATLAS software program. Results: Of the 16 participants in this study, 37.5% reported having an advance directive, well above the estimated 9% for completion of directives among minorities and the estimated 15-20% for the general population. Primary themes expressed by participants during the focus groups included preserving one's quality of life and the fears and discomfort associated with communicating with spouses and children. Conclusion: Asian Indians understand advance directives to be an important tool in their end-of-life care. They do not share the fears expressed by other minority groups and expressed a more independent decision-making style. This study also showed that Indian ethnicity (including religion and cultural norms) was not a major barrier to completing advance directives.