Supporting advance care planning among Mandarin and Cantonese speaking communities: a qualitative exploratory study

Whilst advance care planning (ACP) is important to ensure person-centred end of life care, there is sparse evidence about factors contributing towards engagement for people from Mandarin and Cantonese speaking backgrounds (MCSB) affected by cancer. This study aimed to establish barriers and facilitators for quality ACP among people from MCSB with cancer and carers. A qualitative study utilising semi-structured interviews and focus groups was conducted. Participants included adult community members from MCSB in New South Wales who had accessed cancer care services in Australia as a support person or a patient in the last five years with recruitment done purposefully. Data collected from eligible consenting participants were audio/video recorded, transcribed verbatim and analysed using the Framework Method applying the Theoretical Domains Framework. Eighteen people participated (11 in two focus groups, seven individual interviews). Key barriers to engagement with ACP were unclear understanding of process and conduct, poor quality communication by healthcare staff, resource constraints and cultural misalignment of ACP concepts. The main facilitators were openness of participants to discussions, culturally informed community resources and dedicated ACP services. Co-design provides a useful approach to address varied identified factors. At the system and service level, co-design with these communities and healthcare providers could potentially develop resources to assist these communities in engaging with ACP, including preparing for ACP communication. Understanding and acknowledging cultural factors that impact ACP and integrating this knowledge in ACP communication may enhance engagement.