Abstract：
BACKGROUND: Despite being one of the fastest growing ethnic groups in the U.S., there exists a gap in how treatment preferences among Chinese Americans are expressed and enacted upon in inpatient settings.
OBJECTIVE: To compare the rates of advance care documentation and life-sustaining treatment between Chinese American and White American ICU decedents.
METHODS: In this matched retrospective decedent cohort study, we included four ICUs within a tertiary medical center located in a Chinatown neighborhood. The Chinese American cohort included adult patients during the terminal admission in the ICU with primary language identified as Chinese (Mandarin, Cantonese, Taishanese). The White American cohort was matched according to age, sex, year of death, and admitting diagnosis.
RESULTS: We identified 154 decedents in each cohort. Despite similar odds on admission, Chinese American decedents had higher odds of DNR completion (OR 1.82; 95%CI 0.99-3.40) and DNI completion (OR 1.81; 95%CI, 1.07-1.57) during the terminal ICU admission. Although Chinese American decedents had similar odds of intubation (aOR 0.90; 95%CI, 0.55-1.48), a higher proportion signed a DNI after intubation (41% vs 25%). Chinese American decedents also had higher odds of CPR (aOR 2.03; 95%CI, 1.03-41.6) with three Chinese American decedents receiving CPR despite a signed DNR order (12% vs 0%).
CONCLUSIONS: During terminal ICU admissions, Chinese American decedents were more likely to complete advance care documentation and to receive CPR than White American decedents. Changes in code status were more common for Chinese Americans after intubation. Further research is needed to understand these differences and identify opportunities for goal-concordant care.
OBJECTIVE: To compare the rates of advance care documentation and life-sustaining treatment between Chinese American and White American ICU decedents.
METHODS: In this matched retrospective decedent cohort study, we included four ICUs within a tertiary medical center located in a Chinatown neighborhood. The Chinese American cohort included adult patients during the terminal admission in the ICU with primary language identified as Chinese (Mandarin, Cantonese, Taishanese). The White American cohort was matched according to age, sex, year of death, and admitting diagnosis.
RESULTS: We identified 154 decedents in each cohort. Despite similar odds on admission, Chinese American decedents had higher odds of DNR completion (OR 1.82; 95%CI 0.99-3.40) and DNI completion (OR 1.81; 95%CI, 1.07-1.57) during the terminal ICU admission. Although Chinese American decedents had similar odds of intubation (aOR 0.90; 95%CI, 0.55-1.48), a higher proportion signed a DNI after intubation (41% vs 25%). Chinese American decedents also had higher odds of CPR (aOR 2.03; 95%CI, 1.03-41.6) with three Chinese American decedents receiving CPR despite a signed DNR order (12% vs 0%).
CONCLUSIONS: During terminal ICU admissions, Chinese American decedents were more likely to complete advance care documentation and to receive CPR than White American decedents. Changes in code status were more common for Chinese Americans after intubation. Further research is needed to understand these differences and identify opportunities for goal-concordant care.
摘要：
背景：尽管是美国增长最快的种族之一，在住院环境中如何表达和制定华裔美国人的治疗偏好存在差距。
目的：比较美籍华人和美国白人ICU患者提前护理记录和维持生命治疗的比率。
方法：在这项配对的回顾性死者队列研究中，我们在位于唐人街附近的三级医疗中心中包括了四个ICU。华裔美国人队列包括ICU晚期入院期间的成年患者，主要语言为中文（普通话，粤语,泰山人）。美国白人队列是根据年龄匹配的，性别,死亡的一年,承认诊断。
结果：我们在每个队列中确定了154名死者。尽管入院时的赔率相似，在ICU晚期入院期间，华裔美国人完成DNR（OR1.82;95CI0.99-3.40）和DNI完成（OR1.81;95CI，1.07-1.57）的几率更高。尽管美籍华人有相似的插管几率（aOR0.90;95CI，0.55-1.48），插管后签署DNI的比例更高(41%vs25%)。美籍华人死者的CPR几率也较高（aOR2.03；95CI，1.03-41.6），尽管签署了DNR命令，但三名美籍华人死者仍接受CPR（12％对0％）。
结论：在终端ICU入院期间，美籍华人死者比美国白人死者更有可能完成预先护理文件并接受CPR。气管插管后，华裔美国人的代码状态变化更为常见。需要进一步的研究来了解这些差异并确定目标一致护理的机会。
目的：比较美籍华人和美国白人ICU患者提前护理记录和维持生命治疗的比率。
方法：在这项配对的回顾性死者队列研究中，我们在位于唐人街附近的三级医疗中心中包括了四个ICU。华裔美国人队列包括ICU晚期入院期间的成年患者，主要语言为中文（普通话，粤语,泰山人）。美国白人队列是根据年龄匹配的，性别,死亡的一年,承认诊断。
结果：我们在每个队列中确定了154名死者。尽管入院时的赔率相似，在ICU晚期入院期间，华裔美国人完成DNR（OR1.82;95CI0.99-3.40）和DNI完成（OR1.81;95CI，1.07-1.57）的几率更高。尽管美籍华人有相似的插管几率（aOR0.90;95CI，0.55-1.48），插管后签署DNI的比例更高(41%vs25%)。美籍华人死者的CPR几率也较高（aOR2.03；95CI，1.03-41.6），尽管签署了DNR命令，但三名美籍华人死者仍接受CPR（12％对0％）。
结论：在终端ICU入院期间，美籍华人死者比美国白人死者更有可能完成预先护理文件并接受CPR。气管插管后，华裔美国人的代码状态变化更为常见。需要进一步的研究来了解这些差异并确定目标一致护理的机会。
