ArticleBMC medical ethics2025
Cultural and ethical barriers to implementing end-of-life advance care planning among oncology nursing professionals: a content analysis of open-ended questions.
Article in BMC medical ethics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Willingness to participate in advance care planning among older adults with relatively high educational attainment in a continuing care retirement community of the Beijing-Tianjin-Hebei region: a qualitative study.BMC palliative care · 2026Article
- A Large Language Model-Driven System for Advance Care Planning Training Among Health Care Providers in the Chinese Context: Development and Technical Evaluation.Journal of medical Internet research · 2026Article
- Lessons from the field: culturally grounded approaches to recruiting Chinese American immigrant cancer patients to psycho-oncology trials.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Immersive ethical role-play in undergraduate nursing ethics education: a qualitative descriptive study.BMC medical ethics · 2026Article
- Evaluating a motivational interviewing-based communication program for nurses in advance care planning: a quasi-experimental study.BMC palliative care · 2026Article
- A structured communication model for advance care planning in Chinese oncology nursing: a mixed-methods participatory action research study.BMC palliative care · 2026Article
- Latent profiles of advance care planning engagement among Chinese older adults.BMC public health · 2026Article
- Ethical challenges in end-of-life cancer care: a qualitative study among health-care providers in Iran.BMC palliative care · 2026Article
- Assessment of advance care planning readiness and its determinants among peritoneal dialysis patients in China.Scientific reports · 2026Article
- Ethical considerations of AI integration in palliative care: a qualitative study.BMC palliative care · 2026Article
- Between culture and care: nurses' experiences of end-of-life communication in Ghana.BMC medical ethics · 2026Article
- Nurses' Experience in Providing End-of-Life Care in Intensive Care Unit: A Scoping Review.Healthcare (Basel, Switzerland) · 2026Review
- From cultural constraints to structural resilience: a comparative analysis of end-of-life care policies in China, South Korea, the U.S., and the U.K.Frontiers in public health · 2026Article
- Qualitative study on influencing factors of acceptance of advance care planning in patients with end-stage heart failure based on COM-B theory.Frontiers in public health · 2026Article
- Mechanism for credibility assessment of online health information by medical students in the digital-intelligent age-a grounded theory study in China.BMC medical education · 2025Article
- Palliative Care in Shanghai Communities: Needs, Influencing Factors and Preferences Among Older Adults with Chronic Diseases.Healthcare (Basel, Switzerland) · 2025Article
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Authors and funding
5 authors.
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Abstract
backgroundAdvance care planning (ACP), a cornerstone of ethical end-of-life care, upholds patient autonomy. However, its practice in Confucian-influenced societies, like China, is significantly shaped by cultural norms where family preferences often precede individual choice. This study explored cultural and ethical barriers to ACP implementation among oncology nursing professionals, focusing on tensions between patient-centered care and deeply rooted social norms.
methodsA qualitative thematic analysis was conducted on open-ended responses from oncology hospitals across 22 provinces, 4 municipal cities, and 5 autonomous regions in China. Data were collected via a cross-sectional online survey and analyzed using Braun and Clarke's framework to identify patterns in cultural, ethical, and communicative challenges.
resultsA total of 838 oncology nursing professionals participated in the study. Three main interdependent barriers emerged: (1) Cultural norms, including filial piety (15.6% of codes) and death-related taboos (11.0%), often led to family-mediated decision-making (33.1%) over patient autonomy; (2) Ethical dilemmas involved neglecting patient preferences (24.3%) and conflicts between life-prolonging treatments and quality-of-life considerations (8.1%); (3) Communication challenges arose from information asymmetry (7.9%) and power imbalances, which often silenced patient voices. These factors collectively created systemic obstacles to ACP implementation.
conclusionsContext-specific ACP strategies in China should integrate Confucian ethics into nursing education, support ethics consultation, and develop culturally sensitive communication models. Future research must assess these interventions' impact on balancing cultural values and patient autonomy, advancing equitable end-of-life care in culturally diverse healthcare systems.
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