How Acculturation Influences Attitudes about Advance Care Planning and End-of-Life Care among Chinese Living in Taiwan, Hong Kong, Singapore, and Australia

Abstract

Background: Understanding attitudes towards life and death issues in different cultures is critical in end-of-life care and the uptake of advance care planning (ACP) in different countries. However, existing research suffers from a lack of cross-cultural comparisons among countries. By conducting this comparative study, we hope to achieve a clear understanding of the linkages and differences among healthcare cultures in different Chinese societies, which may serve as a reference for promoting ACP by considering cultural differences. Methods: Our researchers recruited Chinese adults who could communicate in Mandarin and lived in metropolitan areas in Taiwan, Hong Kong, Singapore, and Australia. Focus group interviews were conducted, and the interview contents were recorded and subjected to thematic analysis. Results: Between June and July 2017, 14 focus groups with 111 participants were conducted in four regions. With traditional Chinese attitudes towards death as a taboo, many participants felt it would be challenging to discuss ACP with elderly family members. Most participants also desire to avoid suffering for the self and family members. Although the four regions’ participants shared a similar Chinese cultural context, significant regional differences were found in the occasions at which participants would engage in end-of-life discussions and select settings for end-of-life care. By contrast, participants from Singapore and Australia exhibited more open attitudes. Most participants from Taiwan and Hong Kong showed a preference for end-of-life care at a hospital. Conclusions: The developmental experiences of ACP in Western countries, which place a strong emphasis on individual autonomy, cannot be directly applied to family-centric Asian ones. Healthcare professionals in Asian societies should make continuous efforts to communicate patient status to patients and their family members to ensure family involvement in decision-making processes.

Factors Influencing Older Adults' End-of-Life Care Preferences

“…The study included older adults aged 65 years or older in 2 geriatric wards of a veterans' hospital in Taipei. Participants who (1) had severe auditory or visual impairment, (2) received a diagnosis of moderate or severe dementia, (3) received a diagnosis of major depression, (4) were in a critical condition, such as hemodynamic instability, (5) were participating in a clinical trial, or (6) could not communicate in Mandarin or Taiwanese were excluded.…”

“…For example, Western culture emphasizes personal freedom, independence, and control and highlights the quality of individual life. 5,6 By contrast, Eastern culture, particularly Chinese culture, emphasizes interpersonal relationships, family integrity, and social harmony. 7,8 Most Taiwanese people are deeply influenced by Chinese culture and thus value harmonious relationships and family integrity.…”

“…The exercise of autonomy varies between Eastern and Western societies. For example, Western culture emphasizes personal freedom, independence, and control and highlights the quality of individual life 5,6 . By contrast, Eastern culture, particularly Chinese culture, emphasizes interpersonal relationships, family integrity, and social harmony 7,8 .…”

Posttraumatic growth in colorectal cancer survivors: A systematic review

“…Considering the fact that most of the included studies (19/31) and all the included intervention studies were conducted under a Western culture, it is recommended that more such studies should be carried out in non‐Western countries for better understanding of PTG experience in CRC survivors. The importance of culture and conducing cross‐cultural studies may lie in the following two aspects: (i) Culture plays an important role in human perceptions, thoughts and responses to events, especially when experiencing a traumatic event (Chiang et al, 2021) and (ii) more researchers are realizing the importance of cross‐cultural research to deepen the generalizability of the findings and people's understanding of research phenomena (Chiang et al, 2021; Menon et al, 2018).…”

Slow demographic change and neurological rehabilitation—Part 2: what we can do

“…Orientierung geben Initiativen wie "Gemeinsam Klug Entscheiden", bei denen es um die bewusste Hinterfragung von Maximalmedizin geht [1]. Was als Lebensende wahrgenommen wird, ist jedoch subjektiv, kulturabhängig und wandelbar [6]. Schwerkranke selbst neigen dazu, sich als Last für andere wahr-zunehmen und daher auf Leistungen zu verzichten [11] In den genannten Bereichen sind technisch anspruchsvolle Interaktionen zwischen Maschine und menschlichem Körper nötig.…”