Family Matters: Effects of Birth Order, Culture, and Family Dynamics on Surrogate Decision Making (FR407-B)

Abstract

1.Describe the qualitative methods used to explore filial expectations and family dynamics in surrogate decision making.2.Describe six themes associated with filial expectations and family dynamics in surrogate decision making of firstborn children. Making medical decisions in the context of serious illness is stressful, especially for surrogate decision makers. At the same time, cultural attitudes about medical decision making and filial expectations may lead some surrogates to experience family conflict. To explore filial expectations and family dynamics related to birth order and surrogate decision making among a racially and ethnically diverse sample. Thirteen focus groups with racially and ethnically diverse English- and Spanish-speakers from county and Veterans hospitals, senior centers, and cancer support groups were conducted to describe participants' experiences making serious or end-of-life decisions for others. Filial expectations and family dynamics related to birth order and surrogate decision making were explored using qualitative, thematic content analysis and overarching themes from focus group transcripts were identified. The mean age of the 69 participants was 69 years +/- 14 and 29% were African American, 26% were White, 26% were Asian/Pacific Islander, and 19% were Latino. Seventy percent of participants engaged in unprompted discussions about birth order and family dynamics. Six subthemes were identified within three overarching categories of communication, emotion, and conflict: Communication: 1) unspoken expectations and 2) discussion of death as taboo; Emotion: 3) emotional stress and 4) feelings of loneliness; and Conflict: 5) family conflict and 6) potential solutions to prevent conflict. Birth order and family dynamics can have profound effects on surrogate stress and coping. These findings are consistent across diverse ethnic and racial groups.