Table 1 Illustration of comments, which informed major categories (italics) and themes (bold)

1.a. Approaching challenging transitions

Why can’t we go to rehab before the operation to know what will be happening in rehab? It’s sort of, that’s what I call advanced care. (female, 65–74-years-old)

1.b Making sense of advocacy

I told them (Chinese older people) I’ve been here (community centre) and I listen about this, about this type of planning, but sometimes they’re not ready, because by my mouth Chinese, speaking Chinese, they not believe. They need someone (government official) to come and talk to the community like that and they more believe like that. If I told them they said, ‘Maybe’ … But I try my best. (female, 55–64-years-old)

We made that decision, me and my wife, made and just said no, we aren’t going to tell her (wife’s mother) that she’s on the steroids because if we do, she won’t take them. She needs them. (male, 45–54-years-old)

It's hard to know someone who has been strong and independent all their life, how much input they should have and are capable of having, depending on which day it is that you're asking. (female one, 55–64-years-old)

Theme 2. ACP literacy and communication

2.a. ACP knowledge and experience

Doctors haven’t raised it (ACP) with me. … and I’ve been told that I was a month away from being dead if I didn’t get a transplant. (male, 55–64-years-old)

2.b. Sociocultural attitudes towards death.

There was just an expectation that we’d all look after one another. (female, 75 + −years-old)

I just thought it meant either turning the switch on or off basically. I didn't realise that it was all to do around medication and things like that. (female two, 55-64-years old)

Yeah, some old people (in Chinese culture) just want to live, even though they can’t move, they can’t even get off the bed – they still can eat something, they still want to have a life. (Focus group with interpreter; unable to determine participant)

Theme 3. Challenges contemplating mortality

3.a. Previous life and health experiences

I keep putting it (ACP) off. And I’m put off even more when I look at and aware of what occurs in elder abuse, …, or children often, grabbing that power of attorney very quickly in order to make sure that the house or the money comes to them. (male, 65–74-years-old)

3.b. Planning for hypothetical circumstances

You couldn’t cover everything because we don’t know what’s going to happen to us, do we, in the hospital; anything could happen, so we can’t cover every illness or outcome. (female, 66–64-years-old)

My first thing would be that somehow they find a way to get his kidney working better. Right? So that there’s no need for anything else. … It’s hard work trying to keep him encouraged and to try and look forward to have things. And my view would be that I’d just like him to go in his sleep one night. (female, 65–74-years-old)

(Father said) ‘If something happens to your mother I now want to go in somewhere else and sell the house.’ Well, that was a complete change from what he had told me five years ago. So what … if you lock yourself into too tight an advance care plan (and) things change? (female, 45–54-years-old)