Cultural Considerations among Family Caregivers in Palliative and Hospice Care

Thesis (Ph.D.)--University of Washington, 2019Persisting caregiving burden causes health problems among family caregivers. In this diverse, global society, culturally sensitive care for both patients and their family has been emphasized. Exploring interactions of race/ethnicity and other cultural components with caregiving patterns and coping styles is important. Furthermore, cultural values interacted with race/ethnicity shape different patterns of using social support and coping styles, and thereby explain differing mental health outcomes among family caregivers. Examining the influence of cultural factors is important to develop culturally sensitive interventions targeting potentially modifiable social and cultural factors that delineate coping mechanisms and resilience. This dissertation consists of the introduction (Chapter 1), three manuscripts regarding family caregiving in palliative and hospice care that are presented in three chapters (Chapters 2, 3, and 4) and the conclusion (Chapter 5). Chapter 2 is a quantitative secondary analysis study and examines the effect of the interaction between race/ethnicity and other cultural factors on mental health among family caregivers. The findings of this study suggested that we can refine culturally tailored interventions focusing on modifiable cultural predictors such as family functioning and trust in providers interacted with race/ethnicity for improving mental health among ethnically diverse family caregivers of pediatric patients in intensive care units. Chapter 3 is a qualitative secondary analysis study and aims to identify challenges, possible solutions that are resources for resilience, and expected consequences from hospice dementia caregivers’ perspectives. The findings of this study suggested that there are several resources for enhancing resilience among family caregivers of hospice geriatric patients with dementia. Chapter 4 is a systematic narrative review. This review identified the studies reporting on the interconnected relationships among cultural components and social determinants of health including race/ethnicity, and the impact of these relationships on resilience and coping mechanisms among family caregivers of older adults in palliative and hospice care settings. Overall, my dissertation examines resilience and coping mechanisms, which are differently shaped by potentially modifiable social and cultural factors that are closely related to race/ethnicity among family caregivers. My research will provide guidance for developing culturally tailored interventions to support the patient-family caregiver dyads in palliative and hospice care