The Impact of Advance Care Planning on Quality of Life, Quality of Care and Quality of Death for Asian older People in Palliative and End-of-Life Care:A Scoping Review

Introduction: The ageing population has increased substantially across countries in Asia. With increasing age, a key challenge among older people is deteriorating physical health associated with chronic diseases that contribute to morbidity and mortality. Hence, an increase in demand for long-term care alongside a need for palliative care (PC) is inevitable. Advance care planning (ACP) has been shown to enhance the quality of life (QoL), quality of care (QoC), and quality of death (QoD) for those nearing the end of life (EoL) by enabling individuals to input their preferences for future care. However, the impact of ACP on QoL, QoC, and QoD remains understudied across Asian populations.Aim: This scoping review aims to explore the relationship between ACP and QoL, QoC, and QoD in palliative and end of life care (PEoLC) amongst older Asian people.Methodology: This scoping review was informed by both Arksey and O'Malley’s methodological approach and the JBI Manual for Evidence Synthesis.Results: A decade search of nine electronic databases yielded 1946 records with 21 studies included in the final subset, and through reflexive thematic analysis, we identified four themes and two sub-themes: patient autonomy, inadequate ACP preparation, perception of PEoLC, and factors influencing ACP engagement, with internal and external factors as sub-themes.Conclusion: This scoping review highlighted that most research has focused on the role of patient autonomy in EoL decision-making, suggesting that patient autonomy is a fundamental principle in ACP as patients are encouraged to consider and communicate their life goals, values, and preferences for medical treatment and EoL care, which allows them to make decisions that are aligned with their personal beliefs and wishes. Several studies have explored the barriers influencing EoL decisions and ACP engagement including family members, cultural beliefs, individual perceptions towards PEoLC, personal experiences, and healthcare providers. However, little consideration was given to how ACP affects QoL, QoC, and QoD in Asian older people from their own perspectives