Background Current literature indicate that awareness and uptake of ACP are low among the Chinese-speaking community in Australia. There is a lack of evidence from the community-based Chinese Australians’ perspectives. This study aimed to characterise the attitudes and perceptions of ACP among older Chinese-speaking Australians living in Sydney.

Methods This qualitative study inductively explored participants’ lived experiences to identify significant events and social and cultural factors that influence their values, attitudes, and perceptions of EOL decision-making and ACP. Chinese-speaking participants aged 65 or over, and carers aged 18 and older, were recruited purposively from the metropolitan communities of Sydney. Data were collected through semi-structured one-to-one interviews conducted in Mandarin, Cantonese or English. Data were transcribed and translated into English before coding. Coded data were analysed thematically.

Results Twenty Chinese-Australian participants were recruited (female: male, 14:6). Participants typically preferred to make health-related decisions autonomously. They grounded their decisions on past experiences of illnesses and EOL decision-making of loved ones, personal values, and perceived needs. Family dynamics and intimacy of relationships are influential in deciding the role and responsibility of their family members in ACP. Although these participants were open to ACP, they perceived the needs to do so only when encountering significant changes in one’s health condition or upon admission into residential facility or hospital.

Participants who were female, widowed or divorced and living alone were found to value autonomy in decision-making, and display a high affinity to ACP.

Conclusion The Chinese-speaking older Australians recruited in this study were observed to be open to ACP. Healthcare professionals should avoid cultural stereotyping and allow their patients from any cultural backgrounds to decide how they prefer to approach ACP. Past experiences and family dynamics could be considered as part of ACP discussions.