Advance care planning for frail older people in China: A discussion paper

Abstract

As the aging population, including frail older people, continues to grow in Mainland China, quality of life and end-of-life care for frail older people has attracted much attention. Advance care planning is an effective way to improve end-of-life care for people with advanced diseases, and it is widely used in developed countries; however, it is a new concept in Mainland China. The effects of advance care planning and its acceptability in Mainland China are uncertain because of its culture-sensitive characteristics. The objective of this article is to discuss the serious social issue of caring for frail older people and illustrate the possibility of implementing advance care planning in nursing homes in Mainland China through a review of relevant literature, which will focus on legislation, healthcare system engagement, public engagement, and cultural issues. Recommendations to promote and implement advance care planning include choosing nursing homes as a proper setting, establishing an ethical climate, and enhancing public awareness.

Awareness and Attitudes Toward Advance Care Planning Among Community-Dwelling Older Adults in China: A Mixed-Methods Study

“…4 Advance care planning (ACP), a novel concept to most Chinese, refers to "a process that enables individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate", 5 has not yet received much attention and participation. 6 To enhance expectations with a patient's end-of-life wishes, a practice guide for hospice care (trial) was enacted in China in 2017. With the slow progress of ACP advance at the country level, we need to figure out the level of public consciousness relative to ACP.…”

Community palliative care services on addressing physical and psychosocial needs in people with advanced illness: a prospective cohort study

“…This is likely because dysfunctional communication (such as avoidance, denial, and protective buffering) that prevents reciprocal disclosure of feelings and thoughts was common between cancer patients and their families [26]. The cultural taboo of discussing issues related to death in Chinese community further hinders the communication between patients, family members and healthcare providers on end-of-life care [27,28].…”

Is there a need for advance care planning in China?—an interview survey of healthcare professionals in the neurology department

“…However, in the literature concerning medical practices, the value of ACP is predetermined; it focuses on getting people to understand and accept ACP. A literature review in 2019 provides an overview of relevant studies, and ACP advocacy and practices in nursing homes are considered the appropriate environment to begin this process (17). ACP involves a wide range of wishes and preferences, ranging from daily care to life-saving treatments, and the most controversial dilemmas frequently occur in hospitals.…”

“…This review, and most of the related papers it mentions, focuses on promoting ACP cognition and action but does not focus on the most challenging aspects of ACP practice. The review also introduced a family-centered ACP conversation model widely applicable in Chinese hospitals (17). The problem of this model has been explained earlier.…”