Journal of Palliative Care & Medicine
Open Access

Abstract

A series of cross-cultural studies were conducted to develop and validate a cultural measure, Confucian Orientation Beliefs (COB) Scale. The original 66-item acculturation scale was constructed among Chinese-American immigrants residing in greater Chicago area (n=211) with specific aims to assess a broad range of traditional Chinese beliefs. Through examinations of content validity, internal consistency (α = .86), and an inter-item correlation of .27 (p<.001), the initial exploratory factor analysis (EFA) suggested 3 principal components: familialism (α = .84), male and physician paternalism (α = .82), and death taboos (α = .89). CO among overseas Chinese was found highly positively correlated with American acculturation, attitudes toward life-sustaining treatment, and palliative care usage. A following confirmatory factor analysis (CFA) was supported with a goodness of fit of 0.95 in a relatively smaller Taiwan suburban sample (n = 122). Further EFA and CFA among hospitalized patients from various Taiwan areas (n =508) yielded a slightly different structure: male paternalism, filial piety, and death taboo jointly captured a salient cultural factor (α = .83); a single dimension was revealed as an individual’s propensity to conform to Confucian traditions, and this orientation is specifically related to life-sustaining treatment attitudes (AVE= 55.39, AGFI= .966, p= .009). A data-driven and efficient tool, the 6-item COB scale (short form), was created with strong psychometric properties. While CO remains prominent in modern Chinese-ethnic societies to affect family caregivers’ life-sustaining treatment decision-making, future research is necessary to replicate studies for temporal stability across heterogeneous Chinese-speaking and Confucianism-oriented samples.

Biography

Yvonne Hsiung received her Ph.D. in Palliative Care Nursing in 2011. Being an ethical consultant for terminal patients and family surrogates, her previous research, teaching, and clinical experiences mostly focused on the health promotion, community education, and cultural advance care planning among minority groups in the Greater Chicago Area. She returned to Taiwan in 2012 because her father required cancer care. Now she is at Mackay Medical College teaching courses about Oncology Nursing, Palliative Care, Medical Ethics, Spiritual Nursing Care, and Life and Death Education.

E-mail: yvonnebear@mmc.edu.tw