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International Practice
Promoting advance care planning in Taiwan – a practical approach to Chinese culture
  1. J G Hsieh and
  2. Y W Wang
  1. Hualien Tzu Chi Medical Center, Taiwan


In Taiwan, people are deeply influenced by traditional Chinese culture. People do not want to talk about death in daily conversation. Discussing with elders about the death is still a taboo. We need to develop a culture sensitive strategy to promote advance care planning (ACP) in Taiwan society.

The objectives of this study are to develop a community program to promote ACP discussion among elderly people. We conducted four sessions of focus group and a total of 30 volunteers participated in the study from August to November 2010. The major themes of the focus group included the value of life, previous experiences about medical care, and opinions about ACP. The results of the researches suggested that an introduction video ‘The Four Seasons’ followed by a video about ACP ‘Metaphor of three wise monkeys’ is most appropriate to motivate ACP discussion in a ‘refuse to talk about death’ society. The contents of these two videos were in accordance with Chinese culture. Promotional brochure for ACP also developed with specific cultural characteristics. The feasibility and acceptance of the process were assessed by the palliative care experts and the residents in the community.

The ACP programs for local culture can provide culture-sensitive choices and reflections for elders in Taiwan. They are more likely to discuss their own end-of-life decisions through this program.

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