Objective
To explore the experiences of patients with advanced cancer regarding the timing of ACP.

Methods
This secondary analysis used data from the ACTION cluster-randomized clinical trial. 288 patients with advanced lung or colorectal cancer, WHO performance status 0–3, and with a minimum life expectancy of 3 months were included in this analysis.

Results
The mean time between patients’ cancer diagnosis and the first ACP conversation was 15.3 months (SD:19.4). The average duration from current cancer stage diagnosis to the first conversation was 8.9 months (SD:10.7). The timing of the conversation was perceived as “just right” by 217 (75.3 %) of the patients. Patients who perceived the timing as “too early” were more recently diagnosed with cancer (9.1 months) or with their current cancer stage (5.7 months) than those who did not. Patients perceiving the timing as “too late” had shorter estimated survival times.

Conclusion
Patients with advanced cancer may benefit from earlier ACP than what is currently typically initiated in clinical practice.

Practice implications
When initiating ACP conversations, several aspects should be considered, including patients’ gender, their socio-cultural environment, and their ability to perform daily activities, with or without limitations.@en

Background: Acculturation is the process of two different cultures coming into contact. It is unclear how acculturation influences Chinese immigrants’ engagement in advance care planning due to the complexity and multifaceted nature of both acculturation and advance care planning. Aims: To synthesize evidence regarding the role of Chinese immigrants’ acculturation in their engagement in advance care planning. Design: Systematic mixed-method review, registered in PROSPERO (CRD42021231822). Data sources: EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for publications until January 21, 2021. Results: Twenty-one out of 1112 identified articles were included in the analysis. Of those 21 articles, 17 had a qualitative design and 13 originated from the United States. Three of four quantitative studies reported that higher acculturation levels were associated with better knowledge or higher rate of engagement in advance care planning. Analysis of qualitative studies showed that Chinese immigrants’ engagement in advance care planning was associated with their: (1) self-perceived cultural identity (native or non-native); (2) interpretation of filial piety (traditional or modern); and (3) interpretation of autonomy (individual or familial). To facilitate their engagement, Chinese immigrants prefer an implicit approach, non-family-related initiators, contextualization advance care planning in Chinese culture and using Chinese language. Conclusion: Chinese immigrants’ willingness to engage in advance care planning varied with their acculturation level. To engage them in advance care planning, we recommend adapting the introduction of advance care planning to address people’s perceptions of their cultural identity, filial piety, and autonomy, as well as their preference for certain approach, initiator, context, and language.

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Na _1/2Bi _1/2TiO ₃-based materials have been earmarked for one of the first large-volume applications of lead-free piezoceramics in high-power ultrasonics. Zn ²⁺-doping is demonstrated as a viable route to enhance the thermal depolarization temperature and electromechanically harden (1-y)Na _1/2Bi _1/2TiO ₃-yBaTiO ₃ (NBT100yBT) with a maximum achievable operating temperature of 150 °C and mechanical quality factor of 627 for 1 mole % Zn ²⁺-doped NBT6BT. Although quenching from sintering temperatures has been recently touted to enhance T _F-R, with quenching the doped compositions featuring an additional increase in T _F-R by 17 °C, it exhibits negligible effect on the electromechanical properties. The effect is rationalized considering the missing influence on conductivity and therefore, negligible changes in the defect chemistry upon quenching. High-resolution diffraction indicates that Zn ²⁺-doped samples favor the tetragonal phase with enhanced lattice distortion, further corroborated by ²³Na Nuclear Magnetic Resonance investigations.

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