HKUMed develops and tests a pioneering tool, the 'Advance Care Planning Communication Assessment Tool', to improve the crucial conversations around advance care planning. The research is led by Dr Jacqueline Yuen Kwan-yuk (right) and Dr Steven Chu Tsun-wai.
As Hong Kong moves towards implementing landmark legislation to protect people's end-of-life care wishes, a research team at the LKS Faculty of Medicine at the University of Hong Kong (HKUMed) has developed and tested a pioneering tool to improve crucial conversations behind those decisions.
The 'Advance Care Planning Communication Assessment Tool' (ACP-CAT) – validated for the first time in real-world clinical settings – was used to assess 137 actual medical consultations facilitating advance care planning. The study uncovered serious gaps in current communication practices among doctors, patients and family members, and offers a roadmap for improvement. The findings were published in Palliative Medicine [link to the publication].
Why communication matters in advance care planning
The findings came as Hong Kong prepares to enact the Advance Decision on Life-sustaining Treatment Ordinance in May 2026 – Hong Kong's first legislation giving legal force to advance medical directives (AMDs). These directives empower individuals to record their treatment preferences, such as whether or not they wish to be resuscitated, and protect healthcare providers who follow valid directives.
While the new legislation is a milestone for upholding patient autonomy, HKUMed researchers stress that legal documents alone cannot guarantee quality care.
'An AMD is just a document. What is more important are the conversations that help us understand what matters most to patients as they approach the end of life—a communication process known as advance care planning, or ACP,' said Dr Jacqueline Yuen Kwan-yuk, Clinical Assistant Professor in the Department of Medicine, School of Clinical Medicine, HKUMed, who led the study.
ACP is an ongoing discussion that supports adults at any age or health status in understanding and sharing their personal values, life goals, and preferences regarding future medical care.1 These discussions aim to ensure people receive the care that aligns with their wishes, even if they become too ill to decide for themselves.
Over 90% of Hong Kong patients want a say
In the study, trained raters used the ACP‑CAT to assess audio-recorded ACP conversations between clinicians, patients with advanced cancer or chronic kidney disease, and their families. By analysing 137 ACP conversations from five hospitals and a community hospice in Hong Kong, the researchers found that the tool reliably measured the quality of clinician communication and corresponded with how patients and families perceived these interactions, confirming its usefulness as a framework for training and assessment.
Importantly, over 90% of the interviewed patients wanted to play an active role in deciding their future care, challenging a common belief that Hong Kong patients prefer to leave such decisions to their families or doctors.
Doctors show empathy but patients' life values are often missed
The study found that while doctors explained medical issues clearly and demonstrated empathy, many deeper, valued-based questions were not addressed.
- Surrogate decision-makers rarely addressed: Less than 5% of conversations discussed choosing someone to speak on the patient's behalf, despite Hong Kong's strong cultural tradition of family involvement in end-of-life decisions.
- Life values overlooked: While 70% of discussions explored patients' fears and worries about treatments, only 30% touched on non-medical priorities, such as spending time with family. Almost none of the dialogues discussed which critical functions, like the ability to speak or recognise loved ones, were most important to quality of life.
- Care plans not aligned with patient values: In fewer than one-third of cases, treatment recommendations were explicitly linked to patients' stated values.
'The ACP-CAT bridges the gap between law and practice. It can help clinicians who are trained in this framework move beyond forms and checklists to have meaningful, patient-centred conversations that improve end-of-life care,' said Dr Yuen.
'Working on this study has changed how I approach end-of-life conversations,' said Dr Steven Chu Tsun-wai, first author of the study. 'It reminded me that good communication is about not only explaining treatment options clearly, but also truly understanding what matters most to patients, and whom patients trust to speak on their behalf if they have lost the ability to make decisions.'
Using AI to train doctors in compassionate conversations
Looking ahead, the team plans to integrate the ACP-CAT into clinician training and explore AI technologies to make ACP training widely accessible.
'AI could help to deliver large-scale, realistic practice in empathetic, value-based ACP discussions, especially in Hong Kong where we have too few palliative care specialists and skilled trainers,' said Dr Yuen.
About the research team
The research was led by Dr Jacqueline Yuen Kwan-yuk, Clinical Assistant Professor, Department of Medicine, School of Clinical Medicine, HKUMed; and Dr Steven Chu Tsun-wai, Senior Research Assistant, from the same department. Other team members and collaborators are from The Chinese University of Hong Kong, Haven of Hope Sister Annie Skau Holistic Care Centre, Caritas Medical Centre, Queen Mary Hospital, Grantham Hospital, Tung Wah Hospital, and Icahn School of Medicine at Mount Sinai.
1 Sudore, R. L., Lum, H. D., You, J. J., Hanson, L. C., Meier, D. E., Pantilat, S. Z., Matlock, D. D., Rietjens, J. A. C., Korfage, I. J., Ritchie, C. S., Kutner, J. S., Teno, J. M., Thomas, J., McMahan, R. D., & Heyland, D. K. (2017). Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. Journal of pain and symptom management, 53(5), 821–832.e1. https://doi.org/10.1016/j.jpainsymman.2016.12.331
