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A Systematic Review of Advance Directives and Advance Care Planning in Chinese People From Eastern and Western Cultures

Lee, Mei Ching PhD, RN; Hinderer, Katherine A. PhD, RN, CCRN; Kehl, Karen A. PhD, RN, FPCN

Journal of Hospice & Palliative Nursing: April 2014 - Volume 16 - Issue 2 - p 75–85
doi: 10.1097/NJH.0000000000000024
Feature Articles

There is increasing interest in the role of advance care planning (ACP) and advance directives (ADs) in eliciting patient preferences for future medical care. Whereas Americans from many cultures embrace the concept of autonomy and AD, elements of the Chinese culture may lead to disagreement with ACP. Filial piety, an important concept in Chinese culture, may hinder truth-telling, discussion of poor prognosis, and ACP. The purpose of this systematic review was to examine the empirical evidence about ACP and AD in Chinese people from Eastern and Western cultures. Databases searched were PubMed, EMBASE, CINAHL, PsychInfo, and Cochrane Database of Systematic Reviews. Fifteen publications met the inclusion criteria. Narrative analysis was used and five major themes were extracted: (a) factors predicting preferences for ACP/AD, (b) Chinese-specific considerations related to ACP, (c) decision making in ACP, (d) ACP and AD knowledge, and (e) Chinese cultural aspects of ACP. There was little difference in results from Eastern versus Western countries. Culturally sensitive ACP must be approached with compassion and respect and provide a sense of dignity. A family decision-making model may be more appropriate for discussions with Chinese people about ACP and AD.

Mei Ching Lee, PhD, RN, is assistant professor, School of Nursing, Organizational Systems & Adult Health, University of Maryland, Baltimore.

Katherine A. Hinderer, PhD, RN, CCRN, is assistant professor, Department of Nursing, Salisbury University, Maryland.

Karen A. Kehl, PhD, RN, FPCN, is assistant professor, School of Nursing, University of Wisconsin-Madison.

Address correspondence to Mei Ching Lee, PhD, RN, School of Nursing, Organizational Systems & Adult Health, University of Maryland, Baltimore, 655 West Lombard Street, Suite 311T, Baltimore, MD 21201 (

The authors have no conflicts of interest to disclose.

© 2014 by The Hospice and Palliative Nurses Association.