Religious Leaders’ Experience of Advance Care Planning and Death-Related Discussions With Korean Americans: A Qualitative Study Identifying Obstacles and Strategies

Advance care planning is a critical process that allows individuals to articulate their values and preferences for end-of-life care before a medical crisis occurs. This study explored the challenges that religious leaders experience when engaging in advance care planning and death-related conversations with first- and second-generation Korean Americans, and the strategies employed to overcome these challenges. Using a descriptive qualitative study design, interviews were conducted with 12 religious leaders in the United States who provide spiritual/pastoral care to Korean Americans. Analysis revealed both cultural and structural obstacles to advance care planning. Cultural obstacles include emotional suppression, stigma around death, intergenerational conflict, and religious ambivalence. Structural obstacles included knowledge gaps and misconceptions about advance care planning. Despite these obstacles, religious leaders acted as cultural mediators by employing strategies, such as waiting for emotional readiness, building long-term trust, adapting communication to family needs, reframing death through spiritual narratives, utilizing teachable moments for end-of-life conversations, and offering practical guidance. These findings underscore religious leaders' unique role in bridging health care and cultural values, and highlight the need for community-based, community-specific approaches to improve end-of-life communication and planning for Korean Americans.