Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

Abstract

Background: Asian healthcare professionals hold that patients’ families play an essential role in advance care planning. Aim: To systematically synthesize evidence regarding Asian patients’ perspectives on advance care planning and their underlying motives. Design: Mixed-method systematic review and the development of a conceptual framework (PROSPERO: CRD42018099980). Data sources: EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for studies published until July 27, 2020. We included studies concerning seriously-ill Asian patients’ perspectives on advance care planning or their underlying motives for engaging or not engaging in it. Results: Thirty-six articles were included; 22 were quantitative and 27 were from high-income countries. Thirty-nine to ninety percent of Asian patients were willing to engage in advance care planning. Our framework highlighted that this willingness was influenced not only by their knowledge of their disease and of advance care planning, but also by their beliefs regarding: (1) its consequences; (2) whether its concept was in accordance with their faith and their families’ or physicians’ wishes; and (3) the presence of its barriers. Essential considerations of patients’ engagement were their preferences: (1) for being actively engaged or, alternatively, for delegating autonomy to others; (2) the timing, and (3) whether or not the conversations would be documented. Conclusion: The essential first step to engaging patients in advance care planning is to educate them on it and on their diseases. Asian patients’ various beliefs about advance care planning should be accommodated, especially their preferences regarding their role in it, its timing, and its documentation.

Opportunities and challenges for advance care planning in strongly religious family-centric societies: a Focus group study of Indonesian cancer-care professionals

“…Before starting these discussions, we developed a topic guide based on our systematic reviews of advance care planning in Asia [ 5 , 6 ] and on consultation of various experts on palliative and cancer care, with backgrounds in medical oncology, palliative care, research, and psychology. The focus-group topic guide (Appendix 1 ) addressed: (1) an introduction to the study; (2) participants’ prior knowledge of advance care planning; (3) participants’ perspectives on advance care planning; (4) whether and how advance care planning was practiced at participants’ current workplace, and their ideas about it; and (5) barriers and facilitators for advance care planning.…”

The explorations of the awareness, contemplation, self-Efficacy, and readiness of advance care planning, and its predictors in Taiwanese patients while receiving hemodialysis treatment

“…A study conducted by Ma [45] reported that 35.4% of Taiwanese patients were still receiving dialysis prior to death, 12.2% received cardiopulmonary resuscitation (CPR), and 58.9% signed the DNR orders by family members 24h prior to their death. Similarly, a systematic review of ACP in Asia (n = 36) found that 32-88% of Asian (Hong Kong, 34-88%; China 32-80%; South Korea 59%) patients perceived the benefits of ACP [46,47], and yet, the AD completion rate among the general population is merely 0.5% in Hong Kong [47], 10% among Chinese Americans [48]. The low initiation of ACP might be due to the role of Confucianism in Chinese culture, which prioritizes family-centred decision making [49].…”

Exploring the Motivations for Completing Advance Care Directives: A Qualitative Study of Majority/Minority Israeli People Without Dementia

“…Similar to previous studies examining perspectives regarding advances care planning in general (36,37) and advance directives in particular (38), all participants lacked a clear understanding of the concepts. They tended to conflate advance directives with people's last will or testament, and those in the veteran Jewish and Arab groups even equated them with euthanasia.…”