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Views of Family Caregivers on Advance Care Planning in Advanced Dementia Care in Hong Kong: A Qualitative Thematic Content Analysis Study
Faye Chan, Kuen Lam, Derek Lai, Connie Tong, Christopher Lum, Jean Woo. Health Science Reports, 2025-07-01
Topic: Risk, prevention and care in population studies
Emerging themes include (1) receptive to ACP, (2) mixed emotions, (3) barriers to ACP, (4) family consensus in decision-making, and (5) benefits of ACP. Family caregivers were open to ACP when initiated by the healthcare team, particularly if patients had previously expressed a desire to forgo treatments, experienced prior crisis episodes, or had multiple hospital admissions. They found starting the conversation challenging, and local culture evaded the topic. Other barriers included the interpretation of filial expectation, building family consensus, and ACP knowledge gap. They needed to overcome internal emotional struggle and related barriers to progress the ACP process. The benefits of ACP included family cohesiveness, enhanced family communication, as well as better preparation for the patient's death, such as minimized unfinished business. For families that could not work through the barriers, the ACP process could become stagnant. Healthcare providers could play a pivotal role in facilitating ACP by addressing the ACP barriers. Healthcare professionals can encourage ACP discussion in early dementia care. ACP can raise family caregivers' expectations in end-of-life care. The ACP outcome of quality care is more important than documentation of forgoing life-sustaining treatments or advance (medical) directives. Proper training for healthcare professionals is crucial for initiating and facilitating ACP as well as upholding quality end-of-life care.
Key findings
- Emerging themes include (1) receptive to ACP, (2) mixed emotions, (3) barriers to ACP, (4) family consensus in decision-making, and (5) benefits of ACP.
- Family caregivers were open to ACP when initiated by the healthcare team, particularly if patients had previously expressed a desire to forgo treatments, experienced prior crisis episodes, or had multiple hospital admissions.
- They found starting the conversation challenging, and local culture evaded the topic.
- Other barriers included the interpretation of filial expectation, building family consensus, and ACP knowledge gap.
- They needed to overcome internal emotional struggle and related barriers to progress the ACP process.
Why it matters
This qualitative study in Hong Kong found family caregivers were open to advance care planning when initiated by the healthcare team, but faced emotional, cultural, and knowledge barriers. It concerns end-of-life planning and communication, not treating, curing, or preventing Alzheimer's disease.
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Study details
- Evidence strengthLow
How this study scored 35/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Health Science Reports) |
| Journal's citation record | 0 / 4 | Health Science Reports: journal h-index 46 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Jean Woo: h-index 126 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Chinese University of Hong Kong: institution h-index 1,100 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40642560) |
| Free to read | 2 / 2 | Free to read |
| Total | 35 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Chan, F., Lam, K., Lai, D., Tong, C., Lum, C., & Woo, J. (2025). Views of Family Caregivers on Advance Care Planning in Advanced Dementia Care in Hong Kong: A Qualitative Thematic Content Analysis Study. Health Science Reports. https://doi.org/10.1002/hsr2.70983
Vancouver
Chan F, Lam K, Lai D, Tong C, Lum C, Woo J. Views of Family Caregivers on Advance Care Planning in Advanced Dementia Care in Hong Kong: A Qualitative Thematic Content Analysis Study. Health Science Reports. 2025. doi:10.1002/hsr2.70983. PMID: 40642560.
BibTeX
@article{chan2025-40642560,
author = {Chan, Faye and Lam, Kuen and Lai, Derek and Tong, Connie and Lum, Christopher and Woo, Jean},
title = {{Views of Family Caregivers on Advance Care Planning in Advanced Dementia Care in Hong Kong: A Qualitative Thematic Content Analysis Study}},
journal = {Health Science Reports},
year = {2025},
doi = {10.1002/hsr2.70983},
pmid = {40642560},
url = {https://doi.org/10.1002/hsr2.70983}
}
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