ArticlePloS one2013
United states acculturation and cancer patients' end-of-life care.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
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- Lessons Learned From Implementing a Culturally Tailored Virtual Support Program for Asian American Breast Cancer Survivors With Pain and Depression.Journal of medical Internet research · 2026Article
- Factors Influencing Decision Making for Gastrostomy Tube Placement for People Living with Serious Illness: A Scoping Review.Journal of palliative medicine · 2025Article
- The effect of language discordance on the experience of palliative care: A scoping review.PloS one · 2025Article
- Advance care planning and hospice utilization among Japanese Americans: a scoping review.Proceedings (Baylor University. Medical Center) · 2025Article
- Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic.Journal of clinical and translational science · 2023Review
- Differences in End-of-Life Care between COVID-19 Inpatient Decedents with English Proficiency and Limited English Proficiency.Journal of palliative medicine · 2022Article
- Comparison of End-of-Life Care Between Recent Immigrants and Long-standing Residents in Ontario, Canada.JAMA network open · 2021Article
- Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020Observational
- Aligning use of intensive care with patient values in the USA: past, present, and future.The Lancet. Respiratory medicine · 2019Review
- Latino Ethnicity, Immigrant Status, and Preference for End-of-Life Cancer Care.Journal of palliative medicine · 2019Article
- Article
- Racial variation in the use of life-sustaining treatments among patients who die after major elective surgery.American journal of surgery · 2015Article
Corrections and comments
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Authors and funding
12 authors at 8 institutions in 1 country.
Funding
Abstract
backgroundCulture shapes how people understand illness and death, but few studies examine whether acculturation influences patients' end-of-life treatment preferences and medical care. METHODS AND
findingsIn this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19-item scale developed to assess the degree of "Americanization" in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers' USAS scores predicted patients' communication, treatment preferences, and end-of-life medical care in multivariable models that corrected for significant confounding influences (e.g. education, country of origin, English proficiency). The USAS measure was internally consistent (Cronbach α = 0.98); and significantly associated with US birthplace (r = 0.66, P<0.0001). USAS scores were predictive of patients' preferences for prognostic information (AOR = 1.31, 95% CI:1.00-1.72), but not comfort asking physicians' questions about care (AOR 1.23, 95% CI:0.87-1.73). They predicted patients' preferences for feeding tubes (AOR = 0.68, 95% CI:0.49-0.99) and wish to avoid dying in an intensive care unit (AOR = 1.36, 95% CI:1.05-1.76). Scores indicating greater acculturation were also associated with increased odds of patient participation in clinical trials (AOR = 2.20, 95% CI:1.28-3.78), compared with lower USAS scores, and greater odds of patients receiving chemotherapy (AOR = 1.59, 95% CI:1.20-2.12).
conclusionThe USAS is a reliable and valid measure of "Americanization" associated with advanced cancer patients' end-of-life preferences and care. USAS scores indicating greater caregiver acculturation were associated with increased odds of patient participation in cancer treatment (chemotherapy, clinical trials) compared with lower scores. Future studies should examine the effects of acculturation on end-of-life care to identify patient and provider factors that explain these effects and targets for future interventions to improve care (e.g., by designing more culturally-competent health education materials).
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