Therefore, the aforementioned research findings presented two important concepts: (1) previous studies conducted using questionnaires to survey older adults in order to determine their willingness to sign ADs-related documents have had limited significance; (2) the conventional approach used to deliver group education regarding ADs and concepts related to hospice care to elderly residents at long-term care facilities has limited effectiveness in promoting knowledge concerning EOL care and ACP participation, and is thus is no longer appropriate.