Exploring the Social and Cultural Influences on Advance Care Planning Engagement for Patients Living With Cancer: A Hermeneutic Phenomenology Study

Guided by Leininger's Theory of Culture Care, this hermeneutic phenomenological study explored how social and cultural contexts shape engagement in advance care planning (ACP) among people living with cancer in Taiwan. Semi-structured interviews were conducted with 26 stakeholders, including 8 patients, 7 family caregivers, and 11 healthcare providers, recruited from oncology and ACP outpatient clinics, inpatient wards, and home care services at a tertiary medical center. Data were audio-recorded, transcribed verbatim, and analyzed using Naeem's six-step approach. Six interrelated influences on ACP engagement were identified: socioeconomic circumstances, prior experiences and personal background, religious beliefs and life values, relational dynamics with family and significant others, wider social norms, and political and legal requirements. These factors shaped whether ACP was seen as acceptable, when it was introduced, who was involved in decision-making, and how discussions were negotiated within families and with healthcare professionals. The findings show that ACP engagement in Taiwan is a relational, culturally embedded process. Culturally congruent, nurse-led ACP approaches that address relational, socioeconomic, and legal structural influences are needed to support family-centered cancer care.