A Scoping Review of the Influencing Factors of Community Implementation of Advance Care Planning Based on Cross-Cultural Comparisons

With the aging of the population gradually becoming a global social challenge, the trend of an aging society is deepening continuously. The disease burden of the elderly, the demand for care for those with disabilities, and the pressure at the end of life are also becoming increasingly prominent. Against this backdrop, how to improve the quality of life, especially in the terminal stage, through more planned and effective care arrangements has become a common issue of concern for all countries. Advance Care Planning (ACP), as a key component of palliative care, aims to help adults, in different health conditions, proactively communicate with medical staff and family members about their personal values, life goals, and future medical wishes, especially their care preferences in the end-of-life stage, and make pre-arrangements for future medical choices. It is an effective way to enhance the quality of life at the end of life. Meanwhile, communities, as an important foundation for implementing health policies and promoting public health, are also the primary places where people come into contact with medical and health services in their daily lives. Relevant studies have also shown that a primary health care environment centered on patients and based on family ties is an appropriate starting point for systematically conducting ACP. China's "Healthy China Initiative (2019-2030)" emphasizes health management throughout the life cycle, further highlighting the significant value of promoting ACP in community settings. However, the promotion and practice of ACP are deeply influenced by cultural values. Western culture usually emphasizes individual autonomy, which provides support for the principle of prioritizing individual wishes advocated by ACP; while Chinese culture places more emphasis on family collective decision-making and the ethical concept of filial piety, and there is a widespread taboo on death in society. These factors may restrict the expression of individual medical wishes and the localization of ACP. Therefore, a cultural perspective is the core entry point for understanding the differences in ACP implementation and designing effective promotion strategies. However, most of the current related reviews still focus on a single culture or specific groups, lacking systematic cross-cultural comparisons and failing to integrate culture as a key analytical feature. A scoping review is suitable for systematically sorting out complex, interdisciplinary evidence and integrating diverse research in this field. Therefore, this study aims to systematically compare the key factors influencing the implementation of ACP in communities under different cultural backgrounds through the scoping review method, with the expectation of providing a reference basis for the formation of culturally adaptive ACP promotion strategies.