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BOS2b.003 Developing a culturally appropriate advance care planning program in long-term care facilities in China: stakeholder theory of change workshops
  1. Yuxin Zhou1,
  2. Ariel Wang2,
  3. Clare Ellis-Smith1,
  4. Debbie Braybrook1,
  5. Haixia Feng3 and
  6. Richard Harding1
  1. 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King’s College London, London, UK
  2. 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  3. 3Department of Nursing, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, PR China


Background Advance care planning (ACP) is advocated as a means to centralise older people’s preferences in their end-of-life care. As a complex intervention, the development and implementation of ACP must reflect cultural considerations. However, it remains unclear how ACP can be effectively delivered in China. This study aims to develop an ACP program in long-term care facilities (LTCFs) in China.

Methods We conducted two workshops (one face-to-face, one online) using the theory of change (ToC) method. Forty professional stakeholders (nursing home clinical staff and managers, palliative care specialists and researchers) in China participated. Workshop data were analysed using content analysis and integrated with the results of our realist review and primary qualitative data with mechanisms and contextual influences on ACP implementation in LTCFs. A ToC map was developed to outline causal pathways through which ACP program is expected to work.

Results The causal pathways of ACP program started with five preconditions, including (1) Government, facility leadership and external organisations buy-in; (2) Availability of resources, such as laws and regulations, ACP team and champions, external ACP experts and referral networks; (3) Availability of ACP awareness campaigns and training in the facility; (4) Identification of residents’ readiness and appropriate time to initiate ACP; (5) Conduct and review ACP communication regularly. Interventions that target preconditions include provision of assessment tools and conversation guides, training and supervision for ACP team, and regular debriefing meetings. Long-term outcomes that ACP can achieve were identified from residents (i.e. improved end-of-life care), family (i.e reduced care and financial burden) and staff (i.e. reduced risk to legal disputes) level.

Conclusion Our ToC map demonstrates that ACP can contribute to dying with dignity and shifting the view of death-denying in China. This study informs ACP feasibility testing in China and provides insights into cultural adaptation of ACP in Asian countries.

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