Advance Care Planning among Older Adults of Moroccan Origin: An Interview-based Study

Background/aims: Advance care planning (ACP) is rare among elder migrants for social, cultural, and religious reasons. This study aimed to explore ACP-related knowledge, experience, views, facilitators, and barriers among older adults of Moroccan origin in Belgium. Methods: Semi-structured interviews were conducted in Darija (Moroccan Arabic). General practitioners in Brussels and Mechelen recruited participants. Data were analyzed qualitatively using the constant comparative method. Results: The 25 interviewees (average age, 74 years) lacked advance care planning knowledge and had not discussed it with healthcare professionals. They had discussed burial and residential care wishes with relatives. After a brief explanation, most interviewees did not find advance care planning useful or meaningful, mainly for religious reasons. After more extensive explanation with specific examples, they were more willing to have discussions with their general practitioners and/or relatives. The most frequently mentioned facilitator was general practitioners' provision of information; children's involvement in advanced care planning discussions and the desire to not be dependent on children were also mentioned. Barriers were a lack of knowledge, procrastination or good health, trust in one's children to take over care and make decisions, fear of worrying one's children, the possibility of returning to Morocco, and low education levels. Conclusions: Despite an initial lack of knowledge about advance care planning, many older Moroccan migrants were willing to talk about it and some began it after receiving information in their native language. Care providers should facilitate advance care planning discussions for these patients, paying attention to individual needs and preferences.