Drivers and barriers to participate in advance care planning: insights from Chinese community-dwelling older adults

Abstract Background: Advance care planning (ACP) is effective in enhancing the quality of life during older adults’ end-of-life stage. However, ACP remains a novel concept in China, and the inclination of community-dwelling older adults towards ACP participation remains uncertain. Objectives: To explore the factors that promote or hinderparticipating in ACP from the perspectives of Chinese community-dwelling older adults. Design: This was a descriptive qualitative study that incorporated semi-structured interviews. Methods: Purposive sampling was used to enlist a total of 22 older adults residing in four communities in Chengdu, China. The data were transcribed verbatim and analysed using thematic analysis. Results: The analysis identified four main themes and eighteen subthemes that influenced older adults’ participation in ACP. The four themes were: perspective on death, drivers of ACP participation, barriers to participation, and strategies to promote engagement in ACP. Conclusions: This study highlights drivers and barriers to ACP participation among community-dwelling older adults in China, offering valuable insights for developing targeted interventions to support ACP implementation. Enhanced mortality education and involvement of family members play an important role in promoting ACP engagement.