ArticleBMC medical ethics2025
Navigating the path to planned endings: understanding Chinese older adults' engagement with advance care planning through constructivist grounded theory.
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 3 papers.
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Who cites it
3 citing papers in PubMed.
- Latent profiles of advance care planning engagement among Chinese older adults.BMC 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
- Ritualized relational autonomy in Chinese end-of-life care: balancing Confucian benevolence and individual rights.Frontiers in public health · 2026Article
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3 authors.
Funding
Abstract
backgroundAdvance care planning implementation reveals complex tensions between ethical principles and cultural-specific moral frameworks. Within the Chinese healthcare context, medical decision-making operates within a unique ethical landscape shaped by Confucian values, yet systematic ACP promotion in this context remains limited.
objectiveThis study aims to (1) develop a grounded theory of older adults' engagement with advance care planning in the Chinese context; (2) understand how participants navigate decision-making processes within China's cultural and healthcare systems.
designThe investigation employed Charmaz's constructivist grounded theory methodology guided by Nie's framework of Chinese medical ethics through a three-stage approach across diverse geographical regions in China.
participantsTwenty-five participants (13 males/12 females) aged 60-95 years from representative regions of China.
methodsFollowing Charmaz's constructivist grounded theory methodology, data collection progressed from pre-experimental convenience sampling (3 participants), to Stage 1 purposive sampling (12), and Stage 2 theoretical sampling (13) until saturation. Analysis employed concurrent interviews and constant comparative methods guided by Chinese medical ethical principles.
resultsThe analysis produced the substantive theory "Navigating the Path to Planned Endings," encompassing three interconnected categories: Negotiating Death Discourse, The Locus of Decision, and Systemic Support Infrastructure. "The Locus of Decision" emerged as the core category where participants reconcile individual autonomy, filial obligations, and family harmony.
conclusionsThe theoretical framework reveals complex ethical processes through which Chinese older adults engage with advance care planning, highlighting the crucial role of moral agency where traditional values and modern bioethical principles intersect. These findings necessitate culturally sensitive ACP implementation approaches acknowledging family roles while upholding principles of autonomy and justice.
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