Communication About Advance Directives and Advance Care Planning in an East Asian Cultural Context: A Systematic Review

Jack K.H. Pun

advance directive, advance care planning, communication, review, East Asia, culture

ONF 2022, 49(1), 58-70. DOI: 10.1188/22.ONF.58-70

Problem Identification: In East Asian cultural contexts, advance directive (AD) and advance care planning (ACP) discussions are generally challenging given patients’ unawareness of decision-making rights. 

Literature Search: Selected databases were searched for articles published from January 2000 to December 2020.

Data Evaluation: 21 studies were included and appraised with Critical Appraisal Skills Programme Systematic Review Checklist. 

Synthesis: Five themes emerged: (a) nature of AD and ACP communication, (b) insufficient understanding of the differences between ADs and ACP, (c) late timing of AD and ACP conversations, (d) importance of family participation in AD and ACP communication, and (e) unclear division of responsibilities during end-of-life care. 

Implications for Research: Future research should focus on developing a culturally appropriate AD and ACP communication framework.

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