Investigation on Advance Care Planning Behaviors in Elderly Chronic Disease Patients in the Community

Abstract

BackgroundAs the physical function declines with age, and the disease progresses, elderly chronic disease patients face decreased cognitive function and abilities in communicating medical affairs and making relevant decisions, which will have a certain impact on the expression of end-of-life will. Early implementation of the advance care planning (ACP) for elderly patients will guarantee their medical decision-making autonomy. To facilitate the delivery of interventions to promote the implementation of ACP, it is important to study ACP behaviors and related stages of behavior change in this population.ObjectiveTo investigate ACP behaviors, and stages of behavior change as well as associated factors in elderly chronic disease patients in the community.MethodsFrom May to July 2020, by use of convenience sampling, 410 elderly chronic disease patients were selected from the community with coverage of healthcare services delivered by Hanghai East Road Community Health Center, Zhengzhou, and were invited to attend a survey using the General Information Questionnaire and the Chinese version of Advance Care Planning Engagement Survey. Stepwise multiple linear regression was used to identify the influencing factors of stages of behavior change of ACP.ResultsAltogether, 384 (93.7%) individuals who returned responsive questionnaires were included for analysis. Among the respondents who had been involved in ACP. 42 (10.9%) had "talked with family and friends about the medical decision maker", 39 (10.1%) had "talked with family and friends about medical care", 23 (6.0%) had "talked with the medical decision maker about decision-making flexibility", 12 (3.1%) had "asked doctors questions", but no one was involved in four main ACP behaviors. Two hundred and ninety-two (76.0%) respondents were in the pre-contemplation stage of behavior change, and 92 (24.0%) were in the contemplation stage of behavior change. Of the behavior change constructs, the total score of the knowledge showed no significant differences by socio-demographic factors (P>0.05) , but the total score of the contemplation differed significantly by education level, self-rated disease severity and healthcare-seeking related experience in recent five years (P<0.05) . Stepwise multiple linear stepwise regression analysis revealed that education level, hospitalization experience and medical-decision making in the past five years were associated with the contemplation of behavior change construct (P<0.05) .ConclusionOnly some elderly chronic disease patients in the community had been involved in ACP, and had contemplated ACP behaviors. To promote patient engagement in ACP, it is suggested that medical workers should consider ACP as a continuous process composed of multiple behaviors rather than a single behavior during the delivery of health education, and guide patients to increase their understanding of ACP process based on contemplating their ACP behaviors, as well as offer patients targeted interventions based on their current stage of behavior change.

Keywords

• |advance care planning|aged|chronic disease|stage of behavior change|root cause analysis|trans-theoretical model