Multilevel factors related to advance care planning engagement among Korean older adults: An ecological approach

Key Takeaways for GI Nurses

• Understanding cultural factors is essential when discussing advance care planning with Korean and other Asian patient populations during pre-procedure consultations and care planning discussions
• A multilevel ecological approach reveals that family dynamics, cultural beliefs, and healthcare system factors all influence a patient's willingness to engage in advance directive conversations
• GI nurses should assess individual, family, and community-level barriers when facilitating advance care planning discussions, particularly for high-risk procedures or patients with chronic GI conditions
• Cultural competency in advance care planning can improve patient-centered care and help ensure informed consent processes are truly comprehensive and culturally appropriate

Clinical Relevance

This research has significant implications for GI and endoscopy nursing practice, particularly as our patient populations become increasingly diverse. Korean older adults, like many patients from collectivist cultures, may approach healthcare decisions differently than the typical Western model assumes. In the GI setting, where we frequently care for patients undergoing high-risk procedures or managing chronic conditions like inflammatory bowel disease or colorectal cancer, advance care planning discussions are crucial. Understanding the multilevel factors that influence these conversations can help nurses provide more effective, culturally sensitive care.

The ecological approach highlighted in this study suggests that GI nurses must look beyond individual patient preferences to understand family dynamics, cultural values, and healthcare system barriers. This is particularly relevant during pre-procedure assessments, where we often have limited time to establish rapport and discuss complex care preferences. For patients requiring repeated procedures or those with progressive GI conditions, building cultural competency around advance care planning can strengthen the therapeutic relationship and improve care coordination across episodes.

From an operational standpoint, this research underscores the importance of incorporating cultural assessment tools and interpreter services into our advance care planning protocols. GI units may need to adjust workflow patterns to allow additional time for these crucial conversations with patients from diverse cultural backgrounds, potentially improving both patient satisfaction and clinical outcomes while reducing the risk of misunderstandings about care preferences during critical moments.

Bottom Line

GI nurses must recognize that advance care planning is not a one-size-fits-all conversation, especially with culturally diverse older adult populations. By understanding the multilevel factors that influence Korean and other culturally diverse patients' engagement with advance directives, we can provide more effective, patient-centered care that respects cultural values while ensuring our patients' wishes are clearly understood and documented for high-risk GI procedures and chronic disease management.