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. 2023 Sep;37(8):1063-1078.
doi: 10.1177/02692163231179255. Epub 2023 Jun 13.

The role of acculturation in the process of advance care planning among Chinese immigrants: A narrative systematic review

Tingting Zhu  1 , Diah Martina  1   2   3   4 , Agnes van der Heide  1 , Ida J Korfage  1 , Judith Ac Rietjens  1   5
Affiliations

The role of acculturation in the process of advance care planning among Chinese immigrants: A narrative systematic review

Tingting Zhu et al. Palliat Med. 2023 Sep.

Abstract

Background: Acculturation is the process of two different cultures coming into contact. It is unclear how acculturation influences Chinese immigrants' engagement in advance care planning due to the complexity and multifaceted nature of both acculturation and advance care planning.

Aims: To synthesize evidence regarding the role of Chinese immigrants' acculturation in their engagement in advance care planning.

Design: Systematic mixed-method review, registered in PROSPERO (CRD42021231822).

Data sources: EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for publications until January 21, 2021.

Results: Twenty-one out of 1112 identified articles were included in the analysis. Of those 21 articles, 17 had a qualitative design and 13 originated from the United States. Three of four quantitative studies reported that higher acculturation levels were associated with better knowledge or higher rate of engagement in advance care planning. Analysis of qualitative studies showed that Chinese immigrants' engagement in advance care planning was associated with their: (1) self-perceived cultural identity (native or non-native); (2) interpretation of filial piety (traditional or modern); and (3) interpretation of autonomy (individual or familial). To facilitate their engagement, Chinese immigrants prefer an implicit approach, non-family-related initiators, contextualization advance care planning in Chinese culture and using Chinese language.

Conclusion: Chinese immigrants' willingness to engage in advance care planning varied with their acculturation level. To engage them in advance care planning, we recommend adapting the introduction of advance care planning to address people's perceptions of their cultural identity, filial piety, and autonomy, as well as their preference for certain approach, initiator, context, and language.

Keywords: Asian continental ancestry group; acculturation; advance care planning; emigration and immigration; systematic review.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flowchart for study selection.
Figure 2.
Figure 2.
Coding tree of the role of Chinese immigrant’s acculturation in their engagement in advance care planning.
See this image and copyright information in PMC

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