Background Advance Care Planning (ACP) remains nascent in mainland China since it has yet to be integrated with end-of-life care. While Shenzhen recently became the first city in mainland China to have legalized ACP, the uptake of living wills is rare throughout the country due to institutional and cultural barriers. In this study, we have examined ways in which other Asian countries—with similar values and norms as mainland China—have championed patient-focused end-of-life care practices in a family-centered environment, including culturally adapted ACP. Our findings suggest that the selected countries and territories like Singapore, Taiwan, and Hong Kong, could offer valuable ACP experiences for mainland China, as well as other countries, to consider.
Methods We conducted 10 semi-structured online interviews with palliative care physicians, nurses, and academics with ACP expertise and representation across six Asian countries and territories (Singapore, Vietnam, Taiwan, Hong Kong, South Korea, and Japan). On average, the interviews were 45 minutes long and conducted between January and March 2022.
Results Seven themes emerged from the interviews: Integration of culturally adapted ACP with medical services; system-wide buy-in; death education for the public, for patients and families, and for medical professionals; interdisciplinary teams; and legal changes. Our informants identified examples of how they rolled out ACP and worked to overcome institutional and cultural barriers.
Conclusion These ACP practices could provide lessons for mainland China to consider in embedding more patient-focused end-of-life care in its family-centered system. The examples that were cited by our informants could be tailored to support the roll-out of Shenzhen’s legislation, end-of-life care practices in cities that have yet to implement an ACP legislation, and in places beyond China.
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