Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

SAGE Palliative Medicine & Chronic Care

This episode features Dr Diah Martina (Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands). Asian healthcare professionals hold that patients’ family play a central role in advance care planning and rarely engage patients in it. Despite the wide range of studies on advance care planning in different populations in Asian countries, and despite their variety of methodologies and conceptualizations of advance care planning, there has been no systematic synthesis of their results. This study demonstrates that although a majority of Asian patients regarded advance care planning as necessary, more varied results were produced by studies that examined their actual willingness to engage in it. Willingness to engage in advance care planning was affected not only by patients’ knowledge of their disease and advance care planning, but also by their beliefs: (a) about its advantages or disadvantages; (b) that its concept should be in accordance with patients’ faith and their families’ or physicians’ wishes; and (c) about the presence of barriers to it (e.g. complexities of future planning, socioeconomic dependence, and the unreadiness of the healthcare system). Initial steps toward engaging Asian patients in advance care planning should include: (a) an exploration of their understanding of their disease; and (b) the correction of common misperceptions through education on what advance care planning entails. Advance care planning for Asian patients needs to accommodate: (a) patients’ widely differing beliefs on it; (b) their preferences regarding the way in which values are communicated, that is, when and by whom; and (c) whether or not it is documented.