Asian/Pacific Island Nursing Journal


advance care planning, Chinese culture, generation differences, filial piety, end-of-life care

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Applied Behavior Analysis | Chinese Studies | Cognition and Perception | Health Psychology


The purpose of this research is to explore behavioral, normative, and control beliefs in the discussion of advance care planning (ACP) among older and younger Chinese Americans. Ethnic minority groups have been identified as less engaged in ACP and this represents an ethnic and cultural gap. Older Chinese American adults often have different beliefs and values compared to the younger generation who are more acculturated to American mainstream culture. These differences may hinder the discussion of ACP with Chinese older adults.

A qualitative design was used. The Theory of Planned Behavior guided the development of the interview guide. We recruited 60 Chinese Americans. Prior experience was identified as a theme that influenced attitudes about ACP. We found that older and younger Chinese participants had different beliefs in the norm and control related to ACP discussions, but not in the belief of attitudes about ACP discussions. Both younger and older Chinese American participants believed that ACP was important and necessary. Participants in both clusters expressed that they were ready and willing to engage in ACP discussions with their family members but hesitant to initiate these discussions. The reluctance in discussing ACP with Chinese older adults may be related to the expectations and obligations of Xiao (filial piety) in Chinese culture. This study describes the similarities and differences of beliefs in ACP between older and younger Chinese Americans. We identified barriers and facilitators in behavioral, normative, and control beliefs that can be used to promote ACP for Chinese Americans.