The Influence of Cultural Factors on Advance Healthcare Directives

Abstract Background: Advance directives play a crucial role in end-of-life healthcare decisions, and their effectiveness is widely acknowledged. However, adoption rates of advance directives vary significantly across different cultural contexts. This underscores the need to understand how cultural factors influence perceptions and practices regarding advance directives to improve end-of-life care and ensure patient autonomy. Objective: This scoping review aimed to identify and examine the cultural factors affecting the acceptance, understanding, and utilization of advance directives in diverse cultural settings. Methods: We conducted a systematic literature search from 1998 to 2024 across multiple databases, including PubMed, Scopus, APA PsycINFO, CINAHL, Cochrane Library, and Web of Science, using the Arksey and O'Malley framework. Manual searches were also conducted to supplement our findings. Sixteen studies focusing on the cultural impact of advance directives in various healthcare settings were selected and analyzed. Results: Out of 2606 articles identified, 16 met the criteria, spanning over different populations. Our findings revealed that cultural beliefs, family dynamics, societal norms, and religious values strongly influence attitudes toward advance directives. A significant theme across many cultures was the importance of family involvement in end-of-life planning. These findings underscore the diversity of cultural approaches to end-of-life care and the necessity for healthcare providers to adopt culturally sensitive approaches. Conclusion: Our study highlights the need for healthcare systems to incorporate cultural sensitivities among patients and healthcare personnel. Further exploration of approaches that accommodate cultural diversity is essential to ensure that end-of-life care aligns with individual values and preferences.