ArticleBMC palliative care2025
Cultural interplay in end-of-life care decisions: comparing advance directive beliefs and preferences among adults in the U.S. and Taiwan.
Article in BMC palliative care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- A randomized controlled trial study of a life review art intervention for older adults living alone.Frontiers in psychology · 2025Trial
- Beyond the binary: a nationwide study of physician decision orientations toward artificial hydration in terminal cancer care.The oncologist · 2026Article
- When advance directives clash with family consent: designing an operational framework for end-of-life decision-making in China and Korea.BMC medical ethics · 2026Article
- Deciding on the decision-maker in older adults with cancer: Patient autonomy, physician paternalism, and caregiver support.Journal of geriatric oncology · 2026Article
- The impact of life orientation on advance care planning engagement in surrogate decision-makers of terminal cancer patients: a chain mediation model of social support and uncertainty of disease.BMC palliative care · 2025Article
- Willingness to develop an advance directive: perspectives of older persons at a national referral hospital in Uganda.BMC medical ethics · 2025Article
- Navigating preferences for a trouble-free transition: a grounded theory study among older residents in nursing homes.BMC public health · 2025Article
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Authors and funding
5 authors.
Funding
Abstract
backgroundAdvance directives are essential to advance care planning, allowing individuals to document their end-of-life care preferences in a living, legally binding document. Cultural factors such as collectivism and family values can shape beliefs and preferences toward advance directives.
aimThis study compared beliefs and preferences toward advance directives between American and Taiwanese adults.
designCross-sectional survey. A multivariate logistic regression was used to quantify the differences between groups. SETTING/
participantsAge 18 + residing in the U.S. (n = 166) and Taiwan (n = 186).
resultsCompared to the Taiwanese sample, the U.S. sample had more males (37% vs. 21%), more individuals with a graduate education (53% vs. 22%), and fewer single/unmarried participants (38.9% vs. 46.4%). In the multivariate logistic regressions, adults in Taiwan were 2.5 times more likely to value the importance of having an advance directive (aOR 2.5; 95% CI 1.27-5.12), 7.75 times more open to end-of-life care discussions (aOR 7.75; 95% CI 2.03-29.50), and 1.7 times more likely to allow family and loved ones make medical treatment and care decisions during hospitalization for a serious illness on their behalf (aOR = 1.73; 95% CI 1.08-2.78) compared to adults in the U.S. However, adults in Taiwan were less confident that their loved ones' decisions would align with their personal preferences (aOR = 0.28; 95% CI 0.16-0.47).
conclusionAdults in Taiwan place significant importance on advance directives and demonstrate a greater propensity to engage in end-of-life discussions. They also appear more willing than adults in the U.S. to delegate healthcare decisions to their loved ones. Paradoxically, however, they express concerns about whether these decisions align with their personal preferences, a discrepancy likely influenced by cultural values of filial piety and collectivism in Taiwan.
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