Advance Care Planning - cultural differences

 New research from Advance Care Planning Australia has highlighted how cultural background affects our attitudes and behaviours to end-of-life or advance care planning.

Advance care planning (ACP) gives people control over the care they receive if they become too unwell to speak for themselves and invariably involves planning end-of-life care – a topic considered discomforting in some cultures.

The study found that people born overseas were less likely to complete an Advance Care Directive (ACD) when compared to those born is Australia (22% vs 29%). However they were more likely to have an advance care plan documented for them by a health professional or family member, than Australia-born people (46% vs 35%).

The findings are a result of a robust ACD prevalence study examining the health records of more than 4000 people aged 65+, across Australian hospitals, GP clinics and aged care services.

Previous research has identified cultural differences in attitudes to ACP, with some (particularly ‘Western’) cultural groups preferring individual control over choices, while others tend towards a more family-based or collective approach, evident in some people from Southern Europe and certain Asian countries. Such findings have been linked to the view that frank and open disclosure of medical diagnoses and individual choice can be burdensome, rather than empowering.

The study also found that English language proficiency was an important predictor of completing an ACD, suggesting that availability of interpreters in healthcare settings may assist people to express and document their wishes for future care.

“The study provides important new evidence for healthcare professionals working with culturally and linguistically diverse communities. While there is diversity within all cultures, a focus on autonomy and self-determination may have less resonance with certain cultural backgrounds that place stronger value on the involvement of extended family in making life decisions,” said Dr Craig Sinclair, lead study author and research fellow at the Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR) and UNSW Ageing Futures Institute.

Mary Patetsos, Chair of the Federation of Ethnic Communities Councils of Australia (FECCA) has welcomed the new study.

“This highlights a clear need for doctors and healthcare professionals to be more mindful of cultural difference regarding ACP and to consider that for some people, it’s less about self and more about being part of a family or community. At the heart of advance care planning is respect for choice. That should extend to respecting a person’s cultural world view and the values that inform the way they prefer to make decisions,” said Ms Patetsos.

“The key take-out for healthcare professionals is that culture matters and wherever possible they should tailor their ACP approach to the preferred decision-making style of patients and families, rather than narrowly focussing on completion of ACD forms,” said Dr Sinclair.

Advance Care Planning Australia offers resources translated into 16 languages on their website

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