Background Acculturation is the process of immigrants adapting to the host culture. It is unclear whether and how acculturation influences Chinese immigrants’ engagement in advance care planning.

Aims To synthesize evidence regarding the role of Chinese immigrants’ acculturation in their engagement in advance care planning.

Methods We conducted a systematic mixed-method review, registered in PROSPERO (CRD42021231822). EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for publications until January 21, 2021. We included empirical studies on Chinese immigrants’ acculturation and their engagement in advance care planning.

Results Twenty-one out of 1,112 identified articles were included in the analysis; 17 had a qualitative design, 13 originated from the United States. Three of four quantitative studies reported that higher acculturation levels were associated with better knowledge or higher rates of engagement in advance care planning. Analysis of qualitative studies showed that Chinese immigrants’ engagement in advance care planning was associated with their: (1) self-perceived cultural identity(native or non-native); (2) interpretation of filial piety (traditional or modern); and (3) interpretation of autonomy (individual or familial). To facilitate their engagement, Chinese immigrants prefer an implicit approach, non-family-related initiators, contextualization of advance care planning in the Chinese culture and using Chinese language.

Conclusion We found that Chinese immigrants’ willingness to engage in advance care planning varied with their acculturation level. To support engagement in advance care planning, we recommend taking people’s perceptions of their cultural identity, filial piety, and autonomy into consideration, as well as their preferences for a certain approach, initiator, context, and language.