Advance Care Planning in Chinese Seniors: Cultural Perspectives

In traditional Chinese culture, death was sensitive and mentioning it was sacrilegious and to be avoided. Many Chinese families object to telling the patient a "bad" diagnosis or prognosis, which may hinder the chance in advance care planning (ACP) discussion. While death remains an inevitable consequence of being born, as such, it is important that human beings recognize its inevitability and plan ahead of a good death. Advance care planning enables patients to assert their care preferences in the event that they are unable to make their own medical decisions. In China, a rapidly aging demographic presents additional challenges to quality end-of-life care. The adoption of palliative care in China has been slow, with a curative approach dominating health-care strategies. In this article, we would summarize China's current situation in population aging, palliative care development, and Chinese cultural values on death and dying and review the advance directive and end-of-life care preferences among Chinese elderly patients. Current literature recommended the use of indirect communication approaches to determine Chinese seniors' readiness. In individual practice, using depersonalized communication strategies to initiate the discussion was recommended to determine older Chinese seniors' readiness.