Cultural interplay in end-of-life care decisions: comparing advance directive beliefs and preferences among adults in the U.S. and Taiwan
Journal
BMC Palliative Care
Journal Volume
24
Journal Issue
1
Start Page
104
ISSN
1472-684X
Date Issued
2025-04-15
Author(s)
Abstract
Background: Advance 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.
Aim: This study compared beliefs and preferences toward advance directives between American and Taiwanese adults.
Design: Cross-sectional survey. A multivariate logistic regression was used to quantify the differences between groups.
Setting/participants: Age 18 + residing in the U.S. (n = 166) and Taiwan (n = 186).
Results: Compared 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).
Conclusion: Adults 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.
Aim: This study compared beliefs and preferences toward advance directives between American and Taiwanese adults.
Design: Cross-sectional survey. A multivariate logistic regression was used to quantify the differences between groups.
Setting/participants: Age 18 + residing in the U.S. (n = 166) and Taiwan (n = 186).
Results: Compared 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).
Conclusion: Adults 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.
Subjects
Advance directives
American and Taiwanese adults
Cross-cultural comparison
End-of-life care
Publisher
Springer Science and Business Media LLC
Type
journal article