Advance care planning in the Asia Pacific region: comparative implementation study.

Abstract

Objectives: There is a lack of understanding of the landscape of advance care planning (ACP) in the Asia Pacific, and to our knowledge, no previous comparative study has been performed. This study sets out to map the current landscape of ACP implementation across member sectors within the Asia Pacific Hospice Palliative Care Network (APHN).

Methods: This was a cross-sectional survey of purposively sampled experts and leaders, with at least 5 years of experience in ACP-related practice, from the member sectors of APHN.

Results: There is a rich diversity of approaches to ACP implementation, including its conceptualisation, time of initiation and accessibility across various sectors in the Asia Pacific region. The implementation of ACP as a national or organisational programme is associated with increased perceptions of its uptake and accessibility, particularly within Taiwan, New Zealand and Singapore. In some Asian sectors such as in Hong Kong, India, Indonesia, South Korea, Malaysia, Sri Lanka, Thailand and Vietnam, a more family-led ACP process exists, even if the patient has capacity to make healthcare decisions. Most sectors reported top barriers to ACP as a lack of public awareness (9 out of 15 sectors) and lack of empowerment of healthcare professionals (13 out of 15 sectors) as well as social taboo (11 out of 15 sectors).

Conclusions: National and organisational support for the ACP process, cultural competency in ACP and engagement efforts to raise awareness and address barriers to ACP are important considerations in ACP implementation in the Asia Pacific.