Study Aims: Korean American seniors have a very low completion rate of advance directives. The aim of this study is to describe how children of Korean American seniors affect decision-making at the end of their parent's life in order to understand the low completion rate of advance directives by these seniors.

Methods: Three focus groups (n=26) were conducted with Korean American seniors who were volunteers from senior centers with large Korean memberships. Individual interviews were conducted with seniors prior to the focus group. The focus groups and interviews were conducted in Korean by a Korean social worker.

Results: Respondents were 65.1% female, mean age = 71.2 (S.D.=3.3), and 34.6% married. None of the respondents had completed an advance directive, 75.0% agreed a health care proxy is unnecessary because family can make decisions, 70.8% said it is needed only for people who don't trust family (70.8%), and 65.4% said their family didn't know their preferences regarding CPR Many respondents thought their children would want to keep them alive, regardless of prognosis or the senior's preferences: “As a filial duty, if they can prolong their parents' lives, they may do anything they can do.” “Even if we told them not to, they will try as much as they can.” Most respondents trusted their children to make the best decision: “… I believe my children will wisely make a decision depending on the situation.“ Korean culture was considered influential in decision making by children: “I think the children who are raised in Korea will try to prolong their parents' lives, whereas the children who are raised in the US might think that it would be better to let parents go…” A few respondents felt they should prevail if there was disagreement with children: “I will firmly tell them and the doctors about my preferences. … the most important thing is the patient's opinion, not children's opinions.” “No matter what my son wants, if I want to die, that is it.” Some viewed advance directives as an effective means of ensuring adherence to their preferences: “I think my children will follow what I direct them to do in a written document.” “… I have to state what I want in advance. That way, they will honor my wishes.” Others were doubtful an advance directive would assure their preferences are followed: “Even if I state my wishes, I think my children will make their own decision rather than following my wishes.” Relieving children's burden in making decisions at end-of-life was an incentive to complete advance directives: “If I make a decision in advance, it will be much easier for my children to make a decision when I am in that situation. If not, it will be a burden on them.”

Conclusion: Views about children's role in decision-making at the end of life may partially explain the low completion rate of advance directives by Korean American seniors. Interventions to increase completion rates should address the concerns raised by seniors, and preferably include children.