Tree of peaches: exploring what matters most at the end-of-life among healthy older adults in Taiwan: a qualitative...

Meaningful and proactive end-of-life conversations are crucial for achieving person-centered care and supporting the concept of a "good death". However, death-related taboos and family-centered values continue to hinder such conversations in East Asian societies. Innovative and culturally sensitive strategies are needed to encourage early reflection and dialogue on end-of-life care preferences among healthy older adults.

This study describes the development and preliminary feasibility of a culturally grounded end-of-life conversation game, Tree of Peaches, designed to facilitate discussions about what matters most at the end of life and related care preferences.

The development of Tree of Peaches followed a two-phase design process, including synthesizing literature and consulting with a panel of experts to identify and validate culturally relevant attributes associated with a good death and hospice care. An exploratory descriptive study was then conducted to assess the game's feasibility among 16 healthy older adults residing in a senior community in northern Taiwan. Each small-group session involved self-reflection, prioritization of values, and group discussion. Quantitative data on card selection and weighting were analyzed descriptively; qualitative data were analyzed using qualitative content analysis.

The game engaged participants in reflective dialogues on values and preferences for end-of-life care. Participants prioritized values related to dignity, followed by family emotional protection, physical comfort, and the desire to die at home. Factors discouraging hospice care included self-sacrifice reassurance to preserve family hope, optimistic beliefs, and unfamiliarity with hospice services. The findings highlight how participants navigated tensions between personal values, family love, and cultural expectations in shaping their end-of-life care preferences.

This study suggests that Tree of Peaches, through the integration of gamification and culturally sensitive design, offers a structured platform that may facilitate reflective and value-based discussions about end-of-life preferences among healthy older adults. The findings provide insights into the interplay between personal values and family concerns, contributing to a deeper understanding of how autonomy, interdependence, and a "good death" are negotiated within Taiwanese culture. This tool shows potential for adaptation in broader contexts to support proactive end-of-life conversations, which warrants further evaluation in future studies.