Experiences and perspectives of older people regarding advance care planning: A meta-synthesis of qualitative studies

Abstract

Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.

How Should End-of-Life Advance Care Planning Discussions Be Implemented According to Patients and Informal Carers? A Qualitative Review of Reviews

“…75 Older people saw value in ACP to enable their wishes to be respected, but worried about creating family conflict. 55 Overall, the influences of sociocultural beliefs were particularly strong at end of life. 76 These findings all highlighted how the emphasis on individual autonomy that is fundamental to Western notions of ACP may not be valued by all cultures.…”

“…54 Similarly, in other contexts, some patients had thought more about practical arrangements after death (e.g., finances and funerals) than end-of-life care. 25,46,55 This suggested that some people were more ready to engage in discussions about nonhealth ''administrative'' issues than in their thoughts about health care options.…”

“…53,67 Reviews with other patient groups highlighted mixed perceptions, with some patients and carers preferring earlier discussion, and some preferring to wait until deterioration in health. 39,45,46,55 In the context of cancer, patients and carers preferred to delay ACP discussion until treatment options had been exhausted. 62 Although some research indicated preferences for earlier discussion, other research found that patients may lack readiness to think about ACP and need time to cope with the initial shock of a diagnosis.…”

“…45 The influence of families and religion on the perceived value of ACP came more sharply into focus with cultural diversity. 27e32, 55,75,76 The roles of religion and spirituality were important for African Americans and Latinos/Hispanics, with fatalistic beliefs reducing the perceived value of ACP and leading to a preference for aggressive treatment. 27e32 There were fears among African Americans that written advance documentation would limit health service provision, 29,32 and among Latinos, fears that such documents were immutable, 29 casting suspicion about their usefulness and value.…”

“…30 Familycentered decision making was also an important factor in the perceived value of ACP among African American, Latino, and Asian ethnic groups. 28,30,32,55,72,75 Family-centered decision making could affirm relationships but was also challenging. 72 The concept of filial piety (duty to one's family) may have a dual meaning, emphasizing both the need to preserve life but also to ensure patient wishes and comfort.…”