FEATURE ARTICLE Attitudes Toward Life-Sustaining Treatment: The Role of Race/Ethnicity Eunjeong Ko, PhD, MSW Sunhee Cho, PhD, RN, PMHNP Monica Bonilla, MSW This study explores attitudes regarding life- sustaining treatments between Korean Amer- ican and Mexican American older adults. A cross sectional design was employed to sur- vey 122 older adults residing in an urban area on the West Coast (64 Korean Americans and 58 Mexican Americans). Face to face in- terviews were conducted using a structured questionnaire. Results show that Mexican Americans as compared to Korean American older adults hold more favorable attitudes to- ward life-sustaining treatments. Participants who were male were more likely to have pos- itive attitudes toward life-sustaining treat- ments than female. Findings emphasize the importance of culturally sensitive end-of-life care practices which consider cultural varia- tions in life-sustaining treatment preferences. (Geriatr Nurs 2012;33:341-349) E nd-of-life care planning is complex, yet im- perative for individuals across all racial/ ethnic groups. Among racial/ethnic sub- groups, Mexican Americans and Korean Ameri- cans are fast growing populations. Among these, Mexican Americans are the largest sub- group of Hispanic origin, 1 and Korean Americans are the fourth largest subgroup of Asians. 2 The largest groups of Mexican Americans and Korean Americans are concentrated in the urban areas in the West Coast region of the United States. These increasing racially/ethnically diverse groups heighten the importance of culturally competent health care practices. Understanding individuals’ attitudes toward life-sustaining treatment and the role of race and ethnicity can help practitioners provide improved health care services to diverse individuals at the end of life. Life-sustaining treatment (LST) includes medical treatments that are necessary to sustain life or delay death. The concept of LST, or life support, that is commonly presented in the literature includes mea- sures such as a ventilator, artificial nutrition and hydration, antibiotics, and dialysis. 3,4 They also include less demanding measures including medication, administration of chemotherapy, and antibiotics. 5 The contribution of LST in extending one’s life expectancy is well recognized, yet concerns about using them in some terminal conditions has been debated. 5,6 Some argue that using biomedical interventions to extend life in some terminal cases is not justified considering the patient’s qualify of life, the medical expenses involved, and the burdens on families and heath care professionals. 7-9 Others argue that such life-sustaining interventions provide an opportu- nity for the patient to recover even if by an as-yet-unknown medical advance. 9 Much work has been done to identify the fac- tors that influence a person’s attitudes toward LST. Previous studies 3,10,11 report that race/ ethnicity, physical and mental health, spiritual/ religious beliefs, levels of acculturation, and other individual characteristics influence one’s perspectives on the use of life supports. Among these factors, one of the most significant is racial/ethnic identity. 3,12-14 According to previous studies, 3,13,14 ethnic minorities are more likely to express a preference for LST than white individuals. A recent study 3 examining racial difference in LST preferences found that compared with whites, blacks and Hispanics were more likely to prefer life-prolonging drugs even if there were side effects, and they were less likely to want palliative drugs that could po- tentially shorten their lives. A study that included 4 mixed ethnic groups 12 found that European Americans were least likely to approve of LST or want it personally. Mexican Americans were more likely to hold positive attitudes toward LST in general and indicated that they would per- sonally want those treatments if needed. Korean Americans had the most favorable attitudes to- ward the use of life support treatments but did not want to use them personally. Geriatric Nursing, Volume 33, Number 5 341