Cultural Aspects of End-of-Life Advance Care Planning for African Americans: An Ethnonursing Study

John W. Collins, University of Michigan-Flint, Flint, MI, USA.
Rick Zoucha, Duquesne University, Pittsburgh, PA, USA.
Joan Such Lockhart, Duquesne University, Pittsburgh, PA, USA.
Sandra J. Mixer, University of Tennessee-Knoxville, Knoxville, TN, USA.


INTRODUCTION: Advance directive completion rates among the general population are low, with even lower completion rates among African Americans (AAs). This study's purpose was to identify culturally based meanings, expressions, and traditions of end-of-life (EOL) advance care planning (ACP) and decision making in order to promote culturally congruent nursing care among African Americans. METHODOLOGY: Leininger's Culture Care Theory and Ethnonursing Research Method guided the study. A convenience sample of 21 informants were interviewed in community settings. Data analysis was guided using Leininger's phases of ethnonursing data analysis for qualitative data. RESULTS: Three themes emerged that affect EOL decision making: (a) faith in God and belief in life after death, (b) a strong matriarchal family structure, and (c) fear of talking about death and mistrust of the U.S. health care system. DISCUSSION: AA culture, beliefs, and traditions influence EOL ACP and practices, and must be considered while providing culturally congruent care.