A qualitative study exploring overseas Chinese understanding and experiences of advance care planning

Background: Globally, engaging in advance care planning (ACP) conversations to arrange end-of-life preferences is advocated as a public health issue. Most research on this issue has focused on the general public rather than distinct diaspora/migrant groups. There is evidence to suggest poor end-of-life outcomes are experienced by the Chinese diaspora, but there is a lack of research on their understanding and engagement with ACP. Aims: To explore understanding, experience and views on ACP among members of the Northern Ireland Chinese community. Methods: Semi-structured interviews were held with 17 purposively selected participants connected to voluntary Chinese organisations in Northern Ireland. The interviews were translated and subject to thematic analysis. Findings: Three primary themes were identified: (1) 'Awareness of ACP', (2) 'Cross-cultural influences', and (3) 'Engagement with ACP'. Findings indicated a low level of Chinese diaspora awareness regarding ACP, with misconceptions commonly reported. Traditional Chinese cultures such as filial piety, the role of authority and links to native country were found to be important factors, that influenced awareness, understanding and engagement in ACP. These findings have implications for nurses engaging in ACP conversations. Conclusion: Evidence indicates the need for public health interventions to be cognisant of differing diaspora groups within society. Results suggest that cultural influences play a role in the understanding and engagement with ACP. The importance of the diaspora identity should be considered when initiating and engaging in ACP conversations, alongside the need for culturally appropriate approaches to ensure equitable access and engagement with ACP.