The effectiveness of a modified advance care planning programme

Renli Deng, Jianghui Zhang, Liuliu Chen, Jiarui Miao, Jiazhong Duan, Yeyin Qiu, Doris Leung, Helen Chan, Diana T.F. Lee

Research output: Journal article publicationJournal articleAcademic researchpeer-review

4 Citations (Scopus)


Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. 

Research objective: This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. 

Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. 

Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. 

Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. 

Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. 

Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. 

Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society.

Original languageEnglish
Pages (from-to)1569-1586
Number of pages18
JournalNursing Ethics
Issue number7
Publication statusPublished - 1 Nov 2020
Externally publishedYes


  • Advance care planning
  • end-of-life care
  • frail older people
  • nursing home
  • quality of life

ASJC Scopus subject areas

  • Issues, ethics and legal aspects


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