Promoting advance care planning in Taiwan – a practical approach to Chinese culture

Abstract

In Taiwan, people are deeply influenced by traditional Chinese culture. People do not want to talk about death in daily conversation. Discussing with elders about the death is still a taboo. We need to develop a culture sensitive strategy to promote advance care planning (ACP) in Taiwan society.The objectives of this study are to develop a community program to promote ACP discussion among elderly people. We conducted four sessions of focus group and a total of 30 volunteers participated in the study from August to November 2010. The major themes of the focus group included the value of life, previous experiences about medical care, and opinions about ACP. The results of the researches suggested that an introduction video ‘The Four Seasons’ followed by a video about ACP ‘Metaphor of three wise monkeys’ is most appropriate to motivate ACP discussion in a ‘refuse to talk about death’ society. The contents of these two videos were in accordance with Chinese culture. Promotional brochure for ACP also developed with specific cultural characteristics. The feasibility and acceptance of the process were assessed by the palliative care experts and the residents in the community.The ACP programs for local culture can provide culture-sensitive choices and reflections for elders in Taiwan. They are more likely to discuss their own end-of-life decisions through this program.

What influences patients’ decisions regarding palliative care in advance care planning discussions? Perspectives from a qualitative study conducted with advanced cancer patients, families and healthcare professionals

“…Discussions regarding death and dying issues are still considered as taboo in Taiwan. 7,32,33 This is considered to deprive patients of hope and increase tension between them and their family members (drivers 3-1-1 and 3-2-1). 11 Consequently, palliative care is not typically presented as an option (Theme 3).…”

Do cancer patients with dementia receive less aggressive treatment in end-of-life care? A nationwide population-based cohort study

“…Even with the constant promotion of hospice care in recent years, children are expected to provide their parents with high-intensity treatment unless the parents themselves direct otherwise. If the family members do not insist on aggressive treatment, others may see them as having given up on their parents or lacking in filial piety [ 29 , 30 ]. Therefore, in the absence of advance directives, family members of patients with dementia can have difficulty accepting hospice care or reducing the number of invasive interventions, even if a doctor suggests that doing so is the best course of action.…”

Exploring Behavioral Readiness and Program Strategies to Engage Older Community Residents in Advance Care Planning: A Pilot Mixed-Method Study in Taiwan

“…Further market research will be valuable to understand what types of media older Taiwanese may be psychologically triggered to initiate ACP. Easy-to-access multi-media educational materials should be developed for older Taiwanese [63].…”