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.
Highlights
The concepts of end-of-life care and advance care planning (ACP) originated fromEurope and the United States, with the majority of related research driving from Western countries
Between June and July 2017, 14 focus groups with a total of 111 participants were conducted in Taiwan, Singapore, Hong Kong, and Australia (Table S1)
The participants from the various regions wished to discuss issues regarding their acceptance of end-of-life care with their family members
Summary
The concepts of end-of-life care and advance care planning (ACP) originated fromEurope and the United States, with the majority of related research driving from Western countries. Even among the geographically proximate countries of South Korea, Japan, and Taiwan, where Asian cultures are dominant, significant differences exist in attitudes towards end-of-life care due to differences in traditional cultures, values, religion, and health care systems [5]. 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. 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. 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 desire to avoid suffering for the self and family members
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