Advance care planning among residential care homes for the elderly in Hong Kong : the roles of family members

Abstract

This research investigates the critical need for enhancing Advance Care Planning (ACP) among elderly residents in Hong Kong's Residential Care Homes for the Elderly (RCHEs). Recent legislative changes recognising natural death have underscored the urgency of structured ACP processes. Given that many residents are in their final stages of life and that traditional Chinese values significantly influence decision-making, families often encounter challenges in navigating critical choices. Thus, empowering both residents and their families to articulate their preferences effectively is essential. Methods This study employed a multi-method approach, incorporating thematic synthesis review, retrospective chart analysis, and qualitative research to gain a comprehensive understanding of current practices, challenges and opportunities for integrating ACP into elderly care homes. An implementation programme was developed as a pioneering effort to embed ACP into daily routines, drawing on insights from the multi-method analysis and the prerequisites for successful ACP identified by Gilissen in 2017. Results The findings reveal that ACP's importance is generally well recognised; however, many nurses lack the necessary training and institutional support to facilitate these discussions effectively. Family members expect nurses to take the initiative in these conversations, highlighting the critical role of nursing professionals in guiding the ACP process. Over half of newly-admitted residents retain the cognitive ability to make informed choices about their care within the first year, presenting significant opportunities for structured ACP discussions. Discussion In Hong Kong, elderly residents often rely on their children for decision-making, influenced by traditional values that can complicate healthcare choices. Family members frequently hesitate to make critical decisions, making the timing of ACP discussions crucial. Initiating these conversations during new admissions creates a more natural context for both residents and their families. Nurses are wellpositioned to integrate ACP discussions into daily routines, fostering meaningful dialogues about end-of-life care. Significance The implementation of ACP in RCHEs is vital for honouring residents’ end-oflife wishes and delivering compassionate care. The strategic implementation plan derived from this research outlines specific steps for effectively embedding ACP into daily practices, ensuring sustainability and relevance in care delivery. By emphasising training, cultural sensitivity and supportive policies, RCHEs can cultivate an environment that respects residents' preferences and enhances the overall quality of care.