Preference and Influencing Factors of Advance Care Planning for Chinese Elderly Patients With Chronic Diseases

Abstract

The incidence of chronic diseases among elderly patients increases annually with the accelerating aging process in China. Complications arising from the progression of these diseases may affect the ability of the aged to communicate and make decisions about future medical and personal care. This study aimed to investigate acceptance and influencing factors of advance care planning for community-dwelling elderly patients with chronic diseases in the Republic of China. Using a convergent parallel mixed-methods design, 471 elderly Chinese nationals older than 60 years with chronic diseases were recruited using convenience sampling. Quantitative data collection used Chinese versions of the Elderly Death Attitude Scale, Modified Barthel Index Rating Scale, and the Advance Care Planning Acceptance Questionnaire, followed by 14 patients drawn from the quantitative phase. Interviews were thematically analyzed. The results showed that attitude to death and quality of life were key predictors of advance care planning implementation preference, whereas family support and past medical experience were significant factors. The study highlighted the importance of conducting regular education about death, paying attention to quality of life, providing family support, and discussing past medical experience in order to implement advance care planning for elderly patients with chronic diseases in China.

Older Adults' Behavioral Intentions Toward Advance Care Planning Based on Theory of Reasoned Action

“…Factors affecting an older adult's decision to engage in ACP include age, sex, education level, health status, religious beliefs, knowledge of ACP, personal medical experience, communication with family members, support from family members, medical resources, and cultural sentiments 3,6-14 . A mixed study on older adults with chronic diseases discovered that quality of life, family support, past medical experience, and attitude toward death affected their likelihood of implementing ACP 15 . Another survey study found that the desire among older adults to reduce the burdens of surrogate decision making and older adults' negative experiences with end-of-life care were motivators for ACP 16 .…”

Advance Care Planning Among Elderly Acquired Immunodeficiency Syndrome Patients

“…The process of communicating about one's wishes for future health care is referred to as advance care planning (ACP). Advance care planning enables patients, when conscious and capable of decision making, to rely on their life experiences and values to express their willingness to be treated and cared for when they are dying or when there is progressive deterioration of their condition beyond their control 7,8 . Advance care planning assists patients to prepare for future medical treatment and health care if and when critical illness occurs 7 .…”

“…Generally, ACP is more prevalent in developed countries, such as North America, Australia, and New Zealand, 15-18 and more widely accepted in the medical field, particularly in hospitals, communities, and nursing homes 11,15,19 . In addition to elderly patients, the ACP population comprises parents/guardians of minors with life-threatening illnesses, with the community being extended to patients with malignant tumors, Alzheimer disease, cardiovascular, and other diseases 7,19-21 . Despite the highlighted benefits of ACP in these disease states, little research has been done on the implementation of ACP by elderly AIDS patients in China.…”

“…7,8 Advance care planning assists patients to prepare for future medical treatment and health care if and when critical illness occurs. 7 The implementation of ACP better protects and respects patients' medical autonomy, improves their independent decision-making ability, and enhances the expression of their end-of-life medical care wishes. 9 Furthermore, ACP is often regarded as a means to better use health care resources, 10 because it can prevent ineffective and undesired treatments of patients at their end of life, reduce unnecessary excessive medical treatment, improve the effective utilization and redistribution of medical resources, and reduce the economic burden on families and society.…”

“…11,15,19 In addition to elderly patients, the ACP population comprises parents/guardians of minors with lifethreatening illnesses, with the community being extended to patients with malignant tumors, Alzheimer disease, cardiovascular, and other diseases. 7,[19][20][21] Despite the highlighted benefits of ACP in these disease states, little research has been done on the implementation of ACP by elderly AIDS patients in China.…”