Influencing Factors of Advance Care Planning Participation in Surrogate Decision Maker of Advanced Cancer Patients: a Mixed Methods Systematic Review

Abstract

Background The research field of advance care planning (ACP) for the surrogate decision makers of advanced cancer patients in China is still at the initial stage, and the relevant researches are fragmented and poorly targeted, lacking systematic analysis of the influencing factors. Objective To systematically review the influencing factors of ACP participation in surrogate decision makers of advanced cancer patients, so as to provide a reference for subsequent researches in this field. Methods This study was a mixed-methods systematic review. In April 2022, CNKI, Wanfang Data Knowledge Service Platform, PubMed, EmBase, the Cochrane Library, Web of Science, and CBM were searched by computer for the studies related to influencing factors of ACP participation in surrogate decision makers of advanced cancer patients from the inception to 2022-07-01. After evaluating the quality of literature and extracting information from the included studies, the method of JBI Hybrid System Evaluation Guide was used to integrate quantitative studies and qualitative studies after extracting data separately, and then the themes were summarized, obtaining the influencing factors of the final ACP participation in surrogate decision makers. Results A total of 11 papers were included after literature screening and evaluation of literature quality, including 5 qualitative studies and 6 cross-sectional studies. The final results were integrated into 4 categories of personal factors, external support, information access, and disease status, involving 22 influencing factors such as religious beliefs and clan culture, social network, ACP understanding, and disease development expectation after integrating the analysis results of quantitative and qualitative studies. Conclusion There are multiple influencing factors of ACP participation in surrogate decision makers of advanced cancer patients. Public perception, communication, policies and personal characteristics of surrogate decision makers can affect their ACP participation. Therefore, relevant education should be strengthened to improve public perception, an effective communication mechanism among patients, surrogate decision makers and health care providers should be established, the protection of relevant policies and regulations should be improved to strengthen guidance and intervention on variable factors.

Keywords

• hospice care|advance care planning|terminally ill|surrogate decision maker|root cause analysis|mixed system evaluation