Readiness of Chinese frail old age home residents towards end-of-life care decision making

Abstract

Aims: To identify different approaches to end-of-life care decision-making among Chinese frail old age home residents.

Background: Advance care planning has been recently introduced to older people, family members and health care providers in the local community with the intention of better preparing them for end-of-life care. However, promoting the concept is challenging as the customary beliefs and previous research findings provide little reassurance that Chinese frail older people are ready for this potentially sensitive discussion.

Design: Qualitative study.

Method: Semi-structured interviews were used to evaluate the process of advance care planning and the readiness of the participants for such planning.

Results: The findings revealed five approaches towards end-of-life care decision-making among the frail old age home residents: holding on to life, planning ahead, weighing benefits, avoiding and deferring.

Conclusions: The various approaches to end-of-life care decision-making, which affect the older person's level of engagement in advance care planning, are largely related to individual personal values, beliefs and experiences. The level of readiness of frail residents for advance care planning can be explained as a continuum and has to be interpreted in the personal context.

Relevance to clinical practice: The purpose of identifying various approaches is not to be able to screen for individuals who are more likely to undertake advance care planning. Rather, it is to provide insights into the different responses among frail older people with regard to advance care planning and hence the possible ways of devising a specific emphasis and strategies for engaging individuals in the planning process.