Transformative Education
for Health Professionals

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Advance Care Planning in China: Interprofessional study

Lisa Felber, Mei Ching Lee, PhD, RN, Roger Auth, Nahid Koohkanrizi, Cecilia Kim

The purpose of this project was to explore the attitude towards advance care planning in China through an interprofessional collaborative study. 

It was developed in partnership with the Schools of Medicine, Nursing and Social Work of the University of Maryland Baltimore & University of Hong Kong. 

Faculty and students in both universities assisted in the research study design, data collection, and analysis. 

This project provided an opportunity for students to engage in an interprofessional collaborative project, to work with and gain knowledge from a multidisciplinary team, and to develop skills of communication, teamwork, mutual support and respect in a team setting.

Full project description: 


 Purpose: The purpose of this project was to explore advance care planning (ACP) in China through an interprofessional collaborative research study. The research team included students and faculty from the Schools of Medicine, Nursing, and Social Work of the University of Maryland Baltimore and the University of Hong Kong. Aim 1: Explore the attitudes of advance care planning among Chinese healthcare professionals. Aim 2: provide a learning experience for students in the healthcare field to promote interprofessional collaboration. 


Background: Advance care planning is ‘‘a process that involves preparing for future medical decisions in the hypothetical event that individuals are no longer able to speak for themselves when those decisions need to be made.’’ 1 It is a crucial component in palliative care that requires an interprofessional team approach. It supports the physical and psychological well-being of patients with progressive, non-curable disease and their families. It also decrease the burden at end of life (EOL).2 Last year, 29 million (29,063,194) people worldwide required palliative care at the EOL. 3 With the largest world population, 4 China had 260 million people living with chronic non-curable diseases and had a great demand for palliative care. 5 Discussion of ACP is often initiated by healthcare professionals could identify barriers and facilitate intervention to promote the discussion of ACP. 


Description of Program: Faculty and students from multidiscipline in both universities were involved in the development of the research study. A mixed method of cross-sectional survey and interview were used based upon the theory of planned behavior to explore the attitude of ACP. Recruitment and data collection took place at an international multidisciplinary palliative care conference in Hong Kong. Surveys were offered to Mandarin- speaking Chinese healthcare professionals of varied disciplines attending a conference session entitled “Self-Reflection on Death & Dying”. Of approximately 250 attendees, 106 answered the surveys, and nine in-depth interviews were conducted. 


Results: 106 surveys were collected and nine interviews were conducted. Qualitative data analysis is in progress. For the Quantitative data, participants’ age ranged from 23 to 66 (M=40, SD = 10); female (73%, n=77); Half of the sample were physicians (52%, n=55), one third were nurses (31%, n=35) and 13%, n=14, were social workers Data analysis reveals a positive attitude of ACP across the professions. However, participants describe having no control over and low intention to promote the ACP discussion due to a perceived lack of resources and education for healthcare.


Lesson learned from students: Students expressed a significantly broader understanding of the strengths and skill sets unique to medicine, nursing and social work. They report the diversity in training and perspective across disciplines notably enhanced their research. More importantly, working together with a shared focus on this project brought insight into the critical role of collaboration in interprofessional settings and the value of engaging in interdisciplinary dialogue to improve patient outcomes. This project was conducted over a three week period in which students visited hospitals, hospices, and nursing facilities in Hong Kong. This allowed them to engage with Chinese healthcare professionals and gain further interprofessional perspective and cultural competence. 


Acknowledgment: This study is supported by the University of Maryland Baltimore, Interprofessional Global Health Grant Program.


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