Promoting advance care planning among community-based older adults: a pilot project in Chinese society

TL;DR

This study evaluates a pilot project in Hong Kong aimed at promoting advance care planning among older adults in Chinese society, where such discussions are often avoided.

Contribution

The study introduces a compassionate community service model for end-of-life care in a culturally sensitive context.

Findings

Older adults showed improved sense of community and ACP knowledge after the 8-month pilot.

Participants demonstrated increased readiness to discuss end-of-life care and sign advanced directives.

Community volunteers also reported enhanced quality of life and comfort in discussing EoL topics.

Abstract

While promoting advanced care planning is a priority, knowledge remains unclear about how to prepare the aging community for advanced care planning (ACP) at an early stage (EoL), particularly in Chinese societies where discussions about end-of-life care arrangements are often considered taboo. This study evaluates the effectiveness of the Community Care Plan (CCP) pilot project in Hong Kong, which is a compassionate community service model for EoL care focusing on enhancing quality of life (“good life”) and establishing ACP for older individuals facing health deterioration (“good death” arrangements). The CCP pilot project is built on multidisciplinary collaborative services, including a professional team specializing in ACP, home-visit services by nursing teams, social workers from traditional community centers for older adults, and active community volunteers. The evaluation study employs a single-group pre- and post-test design to assess effectiveness. Following an 8-month pilot project, the mixed linear regression found that 63 eligible older adults showed improvements: an increased sense of community (β = 0.53, p = 0.008), enhanced ACP knowledge (β = 0.42, p < 0.001), more conversations with others (β = 0.16, p = 0.001), and increased readiness and self-efficacy in ACP engagement (e.g., discussing medical treatment at end-of-life with doctors and signing advanced directives). The 70 involved active community volunteers also reported improvements in quality of life, sense of community, ACP knowledge, and increased comfort initiating EoL conversations with others. The study discusses potential policy and practice implications for ACP promotion based on the preliminary findings.