68 Beyond one-size-fits-all: embedding cultural safety for advance care planning in oncology settings

<h3>Aim</h3> To examine perceptions of the appropriateness of Advance Care Planning (ACP) among Culturally and Linguistically Diverse (CALD) populations in oncology and explore preferences for who, needs to do what, where, when and to whom across the phase of ACP. <h3>Background</h3> ACP is a critical process that enables individuals to define, discuss, and document their future healthcare preferences, improving patient-centred care and reducing unwanted interventions. Despite its benefits, ACP uptake remains low particularly among CALD populations- who experience significant disparities in access, awareness, and implementation. Healthcare professionals often report challenges in initiating ACP conversations with CALD patients, contributing to missed opportunities for early and meaningful discussions. Given that individuals from CALD backgrounds comprise approximately 30% of Australia’s population, it is imperative to determine if ACP practices are culturally appropriate concepts and to better understand how to ensure equitable access and culturally appropriate engagement. <h3>Main Narrative</h3> Applying implementation science methods, we explored attitudes towards and preferences for ACP uptake among CALD patients in oncology settings. Recruiting people of Indian and Chinese ethnicity, we used the Action, Actor, Context, Target, Time (AACTT) framework to map ACP processes, identifying misalignments in preferences, expectations, and practice between healthcare providers and CALD patients at key touchpoints across the phases of ACP. Acceptability of current practice at touchpoints spanning ACP phases (preparing for the conversation, having the conversation, creating the document, and enacting the document) varied amongst CALD consumer groups identifying where culturally appropriate interventions are needed to improve opportunity for ACP uptake. <h3>Unique Contribution</h3> This is the first study to systematically map preferences across ACP pathways for CALD populations from the perspectives of both healthcare professionals and CALD consumers. By embedding consumer insights into intervention design, this work has the potential to inform ACP strategies that are inclusive, scalable, and culturally safe. <h3>Implications for Policy and Practice</h3> Findings will inform policy and practice reforms by embedding culturally safe and sensitive approaches to introducing/discussing ACP into routine oncology care. Addressing these barriers is critical to reducing inequities and enhancing opportunities for ACP engagement.