Negotiating Care Across Generations: Healthcare Decision‐Making in Aging Korean American Families

Abstract Family members often play a central role in healthcare decision‐making for older immigrant adults, particularly when language barriers, cultural differences, and caregiving responsibilities intersect. Family‐centered decision making (FCDM) has been proposed as an alternative to shared decision‐making (SDM), a key framework in person‐centered care. However, little is known about how 1.5‐and second‐generation Korean American adult children perceive and navigate family involvement in healthcare decisions for aging family members. The purpose of this study is to explore how Korean American adult children understand family participation in healthcare decision‐making and the factors shaping their involvement in decision‐making process. Semi‐structured interviews were conducted with 12 Korean American adults who had experience supporting older family members in healthcare contexts. Participants were recruited through Midwestern Korean community service organizations and social media networks. A semi‐structured interview protocol was developed in collaboration with a community‐based participatory research team including aging Korean immigrants with chronic health conditions. The protocol focused on participants’ belief about SDM, FCDM, and cultural factors influencing healthcare decision‐making and responses to a vignette depicting family involvement in chronic illness management. Interview data were analyzed using thematic analysis. Five interrelated themes characterized FCDM among Korean American adults: (a) family as the primary decision‐making context, (b) context‐dependent family participation, (c) negotiated authority in family‐centered care, (d) cultural and generational moderators of FCDM, and (e) communication as a condition of family participation. Participants did not describe family involvement as uniformly collectivist or obligatory. Instead, they perceived FCDM as a flexible and relational process that varied based on illness severity, family relationships, generational positioning, and broader sociocultural and structural contexts. Adult children often assumed linguistic, cultural, and healthcare navigation responsibilities for aging parents, while decision‐making authority and caregiving responsibilities were distributed within the family system. Although participants valued collaborative discussions with providers, many described deferring to medical authority when structural or relational dynamics such as power imbalances and role expectations among patients, family members, and providers limited their full participation. These finding conceptualize FCDM as a dynamic process shaped by immigration experiences, intergenerational relationships, cultural values, and healthcare system factors. Healthcare model that center decision‐making solely within the individual patient‐provider relationship may overlook how family relationships, cultural values, and intergenerational dynamics shape healthcare decision‐making in immigrant families. Healthcare practices should support flexible family engagement based on patients’ preferences, recognize relational autonomy, and address structural barriers affecting family caregiving and healthcare navigation to promote health equity for aging Asian immigrant populations.