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Wang X, Wu Y, Bai X, Qiao Q, Yu L, Ge L, Qi L, Zang S. Acceptance level of advance care planning and its associated factors among the public: A nationwide survey. BMC Palliat Care 2024; 23:201. [PMID: 39107758 PMCID: PMC11301855 DOI: 10.1186/s12904-024-01533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model. METHODS A total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP. RESULTS On a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00-83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP. CONCLUSIONS This study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges.
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Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China
| | - Yibo Wu
- School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xinghua Bai
- Department of Radiation Oncology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Qiao Qiao
- Department of Radiation Oncology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Ling Yu
- Phase I Clinical Trails Center, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Lina Ge
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping Area, Shenyang, 110004, Liaoning Province, China
| | - Li Qi
- School of Nursing, Qiqihar Medical University, No.333, Bukui North Street, Jianhua District, Qiqihar City, 161006, Heilongjiang Province, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China.
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Zhou J, Walker A. Adult children and older people's demand for community care services in urban China. Australas J Ageing 2024; 43:239-247. [PMID: 37792447 DOI: 10.1111/ajag.13242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES This paper has two objectives. First, it assesses whether the existing informal care provided by adult children has an impact on older people's propensity to demand community care services. Second, it compares the different statuses of sons and daughters in the formal/informal support trade-off. METHODS The paper is based on an analysis of data from the 2018 wave of the China Longitudinal Ageing Social Survey, within the framework of a revised version of Andersen's model, and applies multilevel models to analyse the effects of adult children's gender, numbers and the quality of their support, on older people's willingness to purchase community care services. RESULTS Older people who had sons as well as daughters demanded fewer services, while the number of sons increased service demand. Regarding sons, community care services compensated for economic support, daily life care and spiritual consolation, but did so only in respect of daily life care from daughters. CONCLUSIONS Many families have only one son or one daughter as a result of the one-child policy and therefore often require support from formal care services. Moreover, there is a distinct gender division and an influential filial culture governing the impact of services on the support provided by adult children. Because ageing in place depends on both informal family support and formal services, this key policy goal is at risk if the latter provides insufficient support to the former.
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Affiliation(s)
- Junshan Zhou
- School of Criminology, People's Public Security University of China, Beijing, China
| | - Alan Walker
- Department of Sociological Studies, The University of Sheffield, Sheffield, UK
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Tan M, Ding J, Johnson CE, Cook A, Huang C, Xiao L, Tang S. Stages of readiness for advance care planning: Systematic review and meta-analysis of prevalence rates and associated factors. Int J Nurs Stud 2024; 151:104678. [PMID: 38262171 DOI: 10.1016/j.ijnurstu.2023.104678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Advance care planning has been widely recommended to respect the medical care preferences of patients in the final stages of life. However, uptake of advance care planning in healthcare settings remains suboptimal. It may be beneficial to take into account individuals' readiness for advance care planning based on the stages to change identified in the Transtheoretical Model. OBJECTIVE To identify the measurements used to assess readiness of advance care planning based on the Transtheoretical Model, to pool the prevalence of readiness stages, and to summarize the factors affecting people's readiness for advance care planning. DESIGN Systematic review and meta-analysis. METHODS We systematically searched the databases of PubMed, EMBASE, The Cochrane Library, CINAHL, and Web of Science for relevant studies from inception to February 2023. A random effects model was used to estimate the pooled prevalence. And a narrative review on the factors associated with stages of readiness was conducted. RESULTS This meta-analysis included 25 studies involving a total of 4237 individuals. The precontemplation stage was the most commonly identified stage of readiness among advance care planning behaviors (26-72 %). The prevalence of readiness stages for advance care planning varied among different types of behavior. The behavior of "talking to health care proxy/family/loved ones about thoughts on quality versus quantity of life" had the highest level of readiness among all listed behaviors, followed by "talking to health care proxy/family/loved ones about living will", "signing a health care proxy form" and "signing a living will", "signing an advance directive", as well as "talking to doctors about living will". Regarding to influencing factors, a majority of sociodemographic and clinical factors did not show consistent associations with readiness, but some studies did suggest potential links with age, health status, countries, type of assessment, core structures of the Transtheoretical Model, and intervention modalities. CONCLUSIONS A majority of individuals were unaware of advance care planning. There is an urgent need to promote readiness for such planning. Starting with preliminary activities such as "talking to health care proxy/family/loved ones about thoughts on quality versus quantity of life" can help initiate advance care planning. Better integration of the Transtheoretical Model and interventions into the research of advance care planning readiness are needed. REGISTRATION Not registered.
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Affiliation(s)
- Minghui Tan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China.
| | - Claire E Johnson
- Palliative Aged Care Outcomes Program, University of Wollongong, Wollongong, Australia
| | - Angus Cook
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Lin Xiao
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China.
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Zhou Y, Wang A, Braybrook D, Ellis-Smith C, Feng H, Gong N, Zhou Z, Harding R. What are the barriers and facilitators to advance care planning with older people in long-term care facilities? A qualitative study. J Clin Nurs 2024. [PMID: 38379365 DOI: 10.1111/jocn.17071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024]
Abstract
AIM To explore the views and preferences for advance care planning from the perspectives of residents, family members and healthcare professionals in long-term care facilities. DESIGN A qualitative descriptive design. METHODS We conducted semi-structured interviews with 12 residents of long-term care facilities, 10 family members and 14 healthcare professionals. Data were analysed using reflexive thematic analysis. The social ecological model was used to develop implementation recommendations. RESULTS We constructed a conceptual model of barriers and facilitators to advance care planning in long-term care facilities, drawing upon four dominant themes from the qualitative analysis: (1) The absence of discourse on end-of-life care: a lack of cultural climate to talk about death, the unspoken agreement to avoid conversations about death, and poor awareness of palliative care may hinder advance care planning initiation; (2) Relational decision-making process is a dual factor affecting advance care planning engagement; (3) Low trust and 'unsafe' cultures: a lack of honest information sharing, risks of violating social expectations and damaging social relationships, and risks of legal consequences may hinder willingness to engage in advance care planning; (4) Meeting and respecting residents' psychosocial needs: these can be addressed by readiness assessment, initiating advance care planning in an informal and equal manner and involving social workers. CONCLUSION Our findings show that residents' voices were not being heard. It is necessary to identify residents' spontaneous conversation triggers, articulate the value of advance care planning in light of the family's values and preferences, and respect residents' psychosocial needs to promote advance care planning in long-term care facilities. Advance care planning may alleviate the decision-making burden of offspring in nuclear families. IMPLICATIONS FOR CLINICAL PRACTICE The evidence-based recommendations in this study will inform the implementation of context-specific advance care planning in Asia-Pacific regions. PATIENT AND PUBLIC CONTRIBUTION Patients and caregivers contributed to the interview pilot and data collection.
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Affiliation(s)
- Yuxin Zhou
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, UK
| | - Ariel Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, UK
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, UK
| | - Haixia Feng
- Department of Nursing, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
| | - Ni Gong
- School of Nursing, Jinan University, Guangzhou, Guangdong, PR China
| | - Zhi Zhou
- Department of Palliative Medicine, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, UK
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Yang F, Leng A, Wang J, Jing J, Leiter RE, Sharma RK, Krakauer EL, Jia Z. Association Between Primary Decision-Maker and Care Intensity Among Patients With Advanced Cancer in Mainland China. Am J Hosp Palliat Care 2023; 40:1349-1356. [PMID: 36598338 DOI: 10.1177/10499091221150768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: In China, decisions regarding the treatment of seriously ill patients are usually made by family caregivers. This study aimed to explore the association between the primary decision-makers and the intensity of care given to patients with advanced cancer in China. Methods: We conducted a survey of family members and other caregivers representing 828 cancer patients who died between July 2013 and July 2016. The survey asked: "After the physician conveyed that the disease is incurable, what treatment did the patient and caregiver prefer?" and "Who was the primary decision-maker?" We compared the treatment intensity with locus of decision-making using multivariable logistic regression, adjusting for socio-demographic and clinical covariates informed. Results: Of the 792 patients in our sample, the majority were male (67·2%), 60 years or older (64·0%), married (82·2%), lived with family (98·2%), had medical insurance (94·8%), earned below-average income (53·5%), lived rurally (61·5%), had a gastrointestinal cancer diagnosis (50·8%), experienced moderate or severe pain (86·3%), never received palliative care (80·4%) and had caregivers as primary decision-makers (70·6%). We found that patients were more likely to receive intensive disease-modifying treatments when the primary decision-maker were their children (adjusted odds ratio [AOR] = 1·86, 95% CI:1·26-2·74), spouse (AOR = 2·04, 95% CI:1·26-3·30), or other caregivers (AOR = 3·46, 95% CI:1·24-9·69). Conclusions: When patients with advanced cancer in China did not make their own medical decisions, they were more likely to receive intensive disease-modifying treatments at the end-of-life. Actions should be taken to better understand and ensure that caregivers' decisions reflect the values and presence of patients.
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Affiliation(s)
- Fei Yang
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Jinan, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Jun Jing
- Department of Sociology and Public Health Research Center, Tsinghua University, Beijing, China
| | - Richard E Leiter
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rashmi K Sharma
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eric L Krakauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
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Chen LC, Tu IT, Yu IC, Tung TH, Huang HP, Lin YC, Beaton RD, Jane SW. The explorations of the awareness, contemplation, self-Efficacy, and readiness of advance care planning, and its predictors in Taiwanese patients while receiving hemodialysis treatment. BMC Palliat Care 2022; 21:180. [PMID: 36242014 PMCID: PMC9561320 DOI: 10.1186/s12904-022-01063-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) is a major chronic illness worldwide, and Taiwan reports one of the highest incidence rates of ESRD with 529 cases per million population (pmp). A number of patients with ESRD patients might require lifelong hemodialysis (HD) or peritoneal dialyses (PD). Due to the progression of dialysis, patients are likely to experience other chronic comorbidities, anxiety and depression, frequent hospitalizations, and higher rates of mortality compared to patients with other types of chronic illnesses. As a result, dialysis patients are prone to experience advance care planning (ACP) needs, such as whether they withdraw from receiving dialysis while approaching their end-of-life (EOL). Yet, existing studies have shown that dialysis patients seldom receive timely consultation regarding ACP and there are limited studies examining ACP amongst Taiwan HD patients. PURPOSE The purpose of this study was to examine ACP awareness, contemplation, self-efficacy and readiness; and factors influencing ACP readiness. DESIGN This cross-sectional descriptive study with convenience sampling was conducted in the out-patient HD unit at a regional teaching hospital in southern Taiwan. A total of 143 ESRD patients undergoing HD treatments were recruited. A 55-item ACP engagement survey containing the subscales of awareness, contemplation, self-efficacy, and readiness was employed. The data were analyzed with t-tests, one-way ANOVAs, Pearson's correlations and multiple regressions. RESULTS The results of our investigation revealed that approximately half of the participants (n = 67, 46.9%) were not informed of ACP. Although they reported considering their EOL, medical decisions and desired care, they demonstrated significantly low self-efficacy in discussing ACP (t= -5.272, p < 0.001). HD duration influenced all four ACP subscales; religious beliefs significantly influenced ACP-self-efficacy and readiness; and marital status, education, and primary decision-maker status significantly influenced ACP-readiness. The predictors of ACP-readiness were high self-efficacy and being the primary decision-maker (Adjusted R2 61%). CONCLUSION Most of the HD patients in this study had low ACP-awareness, contemplation, self-efficacy, and readiness, and most had not completed any ACP-related advance directives (AD). Healthcare professionals should proactively provide HD patients with ACP-related information and answer patients' and medical decision-makers' questions in a timely manner, thereby improving the quality of EOL care.
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Affiliation(s)
- Li-Chen Chen
- Department of Nursing, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - I-Te Tu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - I-Chen Yu
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Ko, Taiwan
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan
| | - Yung-Chang Lin
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Ko, Taiwan
| | - Randal D Beaton
- Psychosocial & Community Health and Health Services, Schools of Nursing and Public Health, University of Washington, Seattle, USA
| | - Sui-Whi Jane
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan.
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Ko, Taiwan.
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Chen DR, Jerng JS, Tsai DFC, Young Y. Gender differences in the intention to withhold life-sustaining treatments involving severe dementia for self and on behalf of parent or spouse. Palliat Care 2022; 21:171. [PMID: 36203170 PMCID: PMC9534740 DOI: 10.1186/s12904-022-01062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/26/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Few studies have explored gender differences in the attitudes toward advanced care planning and the intention to withhold life-sustaining treatments (LSTs) involving severe dementia in Asian countries. We examined gender differences in the attitude toward the Patient Autonomy Act (PAA) in Taiwan and how the gender differences in these attitudes affect the intention to withhold LSTs for severe dementia. We also investigated self–other differences in the intention to withhold LSTs between genders. Methods Between March and October 2019, a structured questionnaire was distributed to hospitalized patients’ family members through face-to-face contact in an academic medical center. Exploratory factor analysis and independent and paired-sample t-tests were used to describe gender differences. Mediation analyses controlled for age, marital status, and education level were conducted to examine whether the attitude toward the PAA mediates the gender effect on the intention to withhold LSTs for severe dementia. Results Eighty respondents filled out the questionnaire. Exploratory factor analysis of the attitude toward the PAA revealed three key domains: regarding the PAA as (1) promoting a sense of abandonment, (2) supporting patient autonomy, and (3) contributing to the collective good. Relative to the men, the women had lower average scores for promoting a sense of abandonment (7.48 vs. 8.94, p = 0.030), higher scores for supporting patient autonomy (8.74 vs. 7.94, p = 0.006), and higher scores for contributing to the collective good (8.64 vs. 7.47, p = 0.001). Compared with the women, the men were less likely to withhold LSTs for severe dementia (15.84 vs. 18.88, p = 0.01). Mediation analysis revealed that the attitude toward the PAA fully mediated the gender differences in the intention to withhold LSTs for severe dementia. Both men and women were more likely to withhold LSTs for themselves than for their parents. Compared with the women, the men were more likely to withhold resuscitation for themselves than for their parents (p = 0.05). Women were more likely to agree to enteral tube feeding and a tracheotomy for their husbands than for themselves; men made consistent decisions for themselves and their wives in those LST scenarios. Conclusion Gender influences the attitude toward advanced care planning and consequently affects the intention to withhold LSTs, indicating that there may be a difference in how men and women perceive EOL decision-making for severe dementia in Taiwan. Further studies are warranted.
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Affiliation(s)
- Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan.
| | - Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Daniel Fu-Chang Tsai
- Department & Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yuchi Young
- Department of Health Policy, Management & Behavior, School of Public Health, New York State University,, Albany, USA
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Shen Y, Zong Y, Yang Y, Wang Y, Suo T, Sun J, Zhang Z, Liu W, Li D, Gao R, Xing C. Acceptance of Advance Care Planning Among Young Adults in Shijiazhuang, China: A Mixed-Methods Study. Am J Hosp Palliat Care 2022:10499091221127983. [PMID: 36129148 DOI: 10.1177/10499091221127983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: In the event of accidental trauma, incurable disease and public health emergencies, young adults are unable to participate in their own medical decisions, family members face the huge decision-making pressure and medical resources of the society were unevenly distributed. Objective: The purposes of this study is to investigate the Advanced Care Planning (ACP) acceptance and examine its influencing factors using sequential explanatory mixed methods in order to provide a basis for the formulation of later interventions. Methods: A cross-sectional study of young adults (N = 785) and 12 other young adults from two other communities were investigated from January 2021 to February 2022. Descriptive statistics and multiple linear regressions were conducted. Content analysis was performed on the qualitative data. Results: The primary factors that contributed to the acceptance of ACP were the natural acceptance of death, being female, having a high level of education, having a loved one diagnosed with a chronic disease, and having heard of ACP. Among young adults, the acceptance of ACP may be impeded by a fear of the unknown nature of death, a poor understanding of ACP, and family-led decision-making. Discussion: Our study found that 77.1% had not heard of ACP before participating in the study and showed potential to accept ACP-related interventions. The study highlighted the importance of implementing regular young adult education courses, promoting routine ACP knowledge, individualized education, discussing family member's disease experiences, conducting family meetings, and identifying young adult responsibilities and roles in implement ACP for young adults in China.
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Affiliation(s)
- Yongqing Shen
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Yijun Zong
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Yanting Yang
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Yongli Wang
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Tingting Suo
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Jiachen Sun
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Zetao Zhang
- Research Center on Combining Medical and Care Services for Seniors, 33133Peking University, Beijing, China
| | - Wei Liu
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Dongli Li
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Rui Gao
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
| | - Caiyi Xing
- School of Nursing, 441322Hebei University of Chinese Medicine, Hebei, China
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Knowledge, attitudes, and behavioral intentions of elderly individuals regarding advance care planning: Questionnaire development and testing. PLoS One 2022; 17:e0272351. [PMID: 35901117 PMCID: PMC9333217 DOI: 10.1371/journal.pone.0272351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background Studies have indicated that the advance care planning knowledge and attitudes of elderly individuals strongly affect their implementation of advance care planning. A measurement with a theoretical base for evaluating elderly individuals’ knowledge, attitudes, and behavioral intentions regarding advance care planning is lacking. Objectives To develop a questionnaire and understand elderly individuals’ knowledge, attitudes, and behavioral intentions regarding implementing advance care planning. Methods A cross-sectional questionnaire survey was conducted. The content validity index, and statistical methods, including discrimination, factor, and reliability analysis, were adopted for psychometric testing. Descriptive statistics mainly presented data analysis. Results 401 elderly individuals were recruited from a medical center and one senior activity center. The content validity index was approximately 0.71–0.92 for the developed questionnaires, the Kuder–Richardson formula 20 was 0.84 for advance care planning knowledge, and the Cronbach’s alpha was 0.86, 0.94, 0.76, and 0.92 for attitudes, behavioral intentions, influencing factors, and subjective norms, respectively. The average score for advance care planning knowledge for elderly individuals was 4.42, with a correct answer rate of 49.1%. They lacked knowledge of advance care planning-related legislation. The mean score for attitudes and behavioral intentions was 14.32 and 3.48, respectively. Elderly individuals agreed that advance care planning has benefits but were worried about the emotional distress caused by advance care planning discussions. Elderly individuals with positive behavioral intentions tend to implement advance care planning. Spouses, children, doctors, and nurses are significant reference people for elderly individuals. Conclusions The developed questionnaire exhibits good validity and reliability for understanding elderly individuals’ knowledge, attitudes, and behavioral intentions concerning advance care planning. Advance care planning materials or decision aids suitable for elderly individuals must be developed to increase their understanding of advance care planning. Additionally, the role of nurses is indispensable in promoting advance care planning among elderly individuals.
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Chen L, Yin G, Lin S, Li Y. The perspectives of family caregivers of people with Alzheimer´s disease regarding advance care planning in China: a qualitative research. BMC Psychiatry 2022; 22:464. [PMID: 35831848 PMCID: PMC9277909 DOI: 10.1186/s12888-022-04106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Advance care planning (ACP) enables people to define goals and preferences for future medical treatment and care. Despite universal recognition of the importance of ACP for people with Alzheimer´s disease (AD) internationally, there is little support for its implementation in China. The viewpoint of family caregivers is crucial in making clinical decisions about AD. Therefore, it's critical to understand the family caregivers' perspectives on ACP in order to promote its practice among people with AD in China. METHODS Seventeen family caregivers of people with AD were purposively selected in three communities in Guangzhou. Semi-structured interviews were conducted to collect data and the data were analyzed using the thematic analysis. RESULTS Three main themes were extracted: ①Attitudes toward ACP including positive and negative attitudes; ②Social pressure influencing ACP decision; ③Behavioral willingness of the implementation of ACP. CONCLUSIONS Attitudes, social pressure, and behavioral willingness characterized the behavioral intentions of family caregivers of people with Alzheimer's disease. It is recommended to strengthen efforts to publicity of advance care planning and promote legislation in China.
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Affiliation(s)
- Linghui Chen
- School of Nursing and Health, Nanfang College, Guangzhou, Guangzhou, China ,grid.13097.3c0000 0001 2322 6764Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King‘s College London, London, UK
| | - Guo Yin
- School of Nursing and Health, Nanfang College, Guangzhou, Guangzhou, China.
| | - Siting Lin
- School of Nursing and Health, Nanfang College, Guangzhou, Guangzhou, China.
| | - Yuanxia Li
- grid.417009.b0000 0004 1758 4591Urology and Organ Transportation Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Xing B, Liang G, Zhang J, Zhang J, Jiang Z, Miao Q. Qualitative assessment of the intention of Chinese community health workers to implement advance care planning using theory of planned behavior. BMC Palliat Care 2021; 20:187. [PMID: 34886846 PMCID: PMC8662910 DOI: 10.1186/s12904-021-00885-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/22/2021] [Indexed: 01/10/2023] Open
Abstract
Background The aging population coupled with progressive medical technology has increased the demand for improved quality of end-of-life in China. However, implementation of an advance care planning (ACP) program in mainland China is still in its infancy owing to the significant influence of filial piety in Chinese culture. Research on implementation of ACP program among community health workers (CHWs) is limited. The current study sought to explore the willingness of CHWs to implement ACP based on the theory of planned behavior (TPB) and provide a reference for promotion of ACP in Chinese communities. Methods Phenomenological qualitative study using semi-structured face-to-face interviews. Interviews were audio-recorded. Colaizzi’s method was used for data analysis. The study received ethical approval and all participants provided written consent. Results Thirteen CHWs from 3 community health service centers (CHSCs) in Hangzhou, Zhejiang Province, China were interviewed. Through the analysis of the interview content, we determined that most CHWs have a supportive attitude towards the implementation of ACP, the reasons for which are as follows: relieve suffering of patients and respect their medical autonomy; relieve economic and psychological burden on family members; promote development of community palliative care. However, some CHWs believe that the implementation of ACP will lead to doctor-patient disputes and medical risks. CHWs reported that the support of patients and their families, community lawyers, psychosocial professionals, and CHSCs senior managers helped them to implement ACP. In addition, they indicated that the improvement of doctor-patient communication ability, the improvement of community medical environment, the support of government policy, and the training of CHWs were the promoting factors influencing their implementation of ACP. The hindrance factors include insufficient allocation of community health human resources, imperfect ACP legislation in China, and deep-rooted traditional culture. Conclusion Findings demonstrated that Chinese CHWs tend to support the implementation of ACP, but their willingness to implement is affected by different factors. CHSCs should actively organize standardized ACP training and comprehensively consider community medical environment, organizational norms, and human resources in implementation of ACP. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00885-1.
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Affiliation(s)
- Bingyu Xing
- Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China
| | - Guanmian Liang
- Nursing Department, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China
| | - Jing Zhang
- Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China
| | - Jinsheng Zhang
- Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China
| | - Zhizhi Jiang
- Kaixuan Street Community Health Service Center, Hangzhou, 310000, China
| | - Qunfang Miao
- Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China.
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