The first Patient Right to Autonomy Act enacted in Asia in 2019 has enabled every Taiwanese citizen to plan for his/her end-of-life (EOL) in case of incompetency. Advance care planning (ACP) has been highly promoted for individuals with terminal, life-threatening illnesses, particularly in the mainstream society, and efforts have been made by the Taiwanese government to train health care providers in order to optimize patients’ quality of dying. However, such advanced decisions and discussions regarding life-sustaining treatment and EOL care remain scarce among older ethnically minority patients. A multiple-case study employing a mixed-method (n = 9) was undertaken to explore indigenous patients’ ACP perceptions. Both quantitative and qualitative information was obtained from indigenous patients, a minority group whose socio-economic and educational status are different from the general Taiwanese population. An initiative was made to describe ACP behavioral awareness, intention, and readiness of older terminal patients from four tribes with seven late-stage cancers in remote, mountainous areas of eastern Taiwan. Our findings showed that according to the Transtheoretical Model, terminal indigenous patients’ ACP readiness was at a precontemplation stage. Their lack of fundamental ACP awareness, insufficient healthcare resources, life-sustaining value in a Christian faith context, and the prevalent health disparity in the remote communities have negatively affected indigenous patients’ intention to participate in ACP. We provide suggestions to further promote ACP in this group and suggest that health information should be tailored at various readiness stages in order to overcome barriers and decrease ACP literacy discrepancies. This study calls attention to an understudied area of ACP behaviors, an overlooked need in EOL care for older cancer patients of unique cultural backgrounds, and the imperativeness to ensure cultural minority group’s EOL care is consistent with patients’ preferences.

Taiwan was the first Asian country to endorse patient autonomy, and advance care planning (ACP) has been highly promoted to improve quality of end-of-life (EOL). A mixed-methods pilot survey was conducted in northwestern Taiwan to investigate older community-dwelling residents’ (N = 52) ACP behavioral engagement, socio-demographical correlates, and their preferred intervention strategies. An interview subset (25%, N = 13) was purposely chosen for in-depth feedback and rationales behind their ACP decision-making. Rich information was obtained about perceived facilitators and inhibitors to initiate ACP and preferred intervention strategies in ACP programs. Consistent with previous literature, carefully designed ACP programs that incorporated family decision-making and met older subjects’ multiple needs would increase program acceptability and foster ACP engagement among older Taiwanese in the community setting.

Fatigue is one of the most distressful problems faced by terminally ill cancer patients, but few studies have explored fatigue experiences in this population. The purpose of this descriptive correlational study was to examine fatigue status and its related factors in terminally ill cancer patients in an institutionalized hospice in Northern Taiwan. Data were collected using the Fatigue subscale of the Profile of Mood States, modified Symptom Distress Scale, Hospital Anxiety and Depression Scale, Karnofsky's Performance Status Index and a background information form. We found that patients generally had moderate to severe levels of fatigue. Fatigue was associated with the overall symptom distress, depression, anxiety, and performance status. Furthermore, fatigue was significantly correlated with 8 individual distressful symptoms: nausea, vomiting, lack of appetite, sleep disturbance, dyspnea, dry mouth, restlessness, and problems of concentration. These results suggest that fatigue is still a problem faced by terminally ill cancer patients. To provide better care to this population, the above-mentioned fatigue-related factors should be simultaneously assessed and cared for. The authors recommend examining the causal relationship between these factors and fatigue, using symptom cluster concepts and skills to examine the possible shared mechanisms among fatigue and related symptoms and developing interventions to decrease fatigue in terminally ill cancer patients.