| Objective: This study aims to develop an assessment tool and construct an intervention plan based on the cognitive characteristics of advance care planning for patients with chronic diseases based on the connotation mining of the cognition of advance care planning of patients with chronic diseases,and to evaluate its impact on the health of patients with chronic diseases.The impact of outcomes can provide a basis for enriching the research in the domestic nursing field to promote the practice of advance care planning and promote the health management of patients with chronic diseases.Methods: The sequential exploratory design of "quality + quantity + quantity" in the mixed research design method was adopted,which was divided into four parts,as follows:1.A qualitative study on the cognitive connotation of advance care planning for patients with chronic diseasesBased on a qualitative research design,a descriptive qualitative research method was used to conduct semi-structured interviews with 21 patients with chronic diseases.The content analysis method combined with the Nvivo12 software was used to code and analyze the interview results,and to mine the cognitive connotation and cognitive characteristics of advance care planning for patients with chronic diseases to form an item pool of cognitive assessment scales for pre-established advanced care planning for patients with chronic diseases.2.Development of cognitive assessment scale for advance care planning for patients with chronic diseases and evaluation of the applicability of the scale(1)Delphi method to determine the predictive version of the scale.After the item pool was revised through group discussion,the Delphi expert consultation method was used to invite relevant experts to participate in the revision and improvement of the scale,to determine the factor structure of the scale and the indicators of each item,and to form a predictive scale after pre-investigation.(2)Exploratory factor analysis to optimize the predictive version of the scale.A cross-sectional study design was used to conduct a questionnaire survey on the predictive scale of 250 patients with chronic diseases.The data analysis included feasibility analysis,item analysis,validity analysis and reliability analysis to evaluate and optimize the predictive version of the scale to form the official version of the scale.(3)Confirmatory factor analysis was used to evaluate the applicability of the formal scale.A questionnaire survey was conducted on 367 patients with chronic diseases,and the structural stability of the scale factors was tested by confirmatory factor analysis and reliability analysis.Data sorting and analysis were completed using SPSS 26.0 and AMOS 24.0 statistics.3.Investigation on factors influencing cognition of advance care planning in patients with chronic diseasesThis study used a cross-sectional design,a questionnaire survey was conducted on 470 chronic disease patients in Yanbian area to explore the related factors and influencing factors of the cognition of the advance care planning in the chronic disease patients.The indicators were general demographic characteristics,disease characteristics,medical experience characteristics,health Literacy,patient participation attitude,family intimacy and family adaptability,trust in medical treatment,etc.Data sorted and analysis were carried out with the help of SPSS26.0,and the statistical methods included univariate analysis and multivariate analysis.4.Evaluation of cognitive intervention effect of advance care planning for chronic disease patientsAccording to the results of qualitative research and analysis of influencing factors,an intervention plan was formulated.142 chronic disease patients were recruited,71 in the intervention group and 71 in the control group,and a 3-month non-randomized concurrent controlled trial was conducted to test to examine the effect of cognitive intervention on the advance care planning for chronic disease patients.The intervention effect of plan cognition,the test indicators include advance care planning cognition,advance care planning readiness,disease perception,death anxiety and disease self-management behavior.SPSS 26.0 software was used for data entry,sorting and analysis.Statistical methods included descriptive analysis,cross chi-square test,independent sample t test,paired sample t test and non-parametric test.Result:1.A qualitative study on the cognitive connotation of advance care planning in patients with chronic diseasesThrough transcription coding,concept extraction,and topic excerpts from the interview data of21 chronic disease patients,the following three categories and six cognitive theme are summarized: knowledge and concept recognition,ability perception,and situation perception,which are the project library of the framework research project.An item library is formed,with a total of 37 items.2.Development and applicability evaluation of the cognitive assessment scale for advanced care planning for patients with chronic diseases(1)The response rates of the two rounds of Delphi consultation questionnaires were 72.0% and88.9%,respectively.Among them,14 experts in the first round put forward revision opinions,and put forward a total of 52 suggestions.In the second round,7 people proposed amendments,and a total of 12 amendments were proposed.The authoritative coefficients of the two rounds of experts are suggested to be 0.828 and 0.834,respectively.The average range of expert opinion concentration in the first round is 3.89～4.94,and the frequency of full marks is between 11.1% and 94.4%;if they are all above 4.13 points,then the letter is over.The second round of expert consultation was integrated and revised,and the scale was improved to form a scale with 36 items in 6 dimensions.Through the pre-investigation of 40 patients with chronic diseases,2 items were deleted to form a prediction scale with 34 items in 6 dimensions.(2)The analysis of 250 chronic disease patient questionnaires showed that the overall Cronbach’s alpha of 34 items was 0.931.In the item analysis,neither the key ratio analysis nor the item correlation analysis deleted items,and the internal consistency analysis deleted 2items.Principal component factor analysis removed 1 item,item analysis removed 3 items;exploratory factor analysis was performed on 31 items,using orthogonal rotation,maximum variance method,the first exploratory factor analysis showed 7 eigenvalues > 1 The common factor is 1,and the items with common factor variance < 0.4 and factor loading ≥ 0.4 were deleted in the multi-factor,a total of 7 items were deleted;no items were deleted in the reliability analysis;the second exploratory results of the 24-item gender factor analysis showed that,the structure of the 6 factors is stable,that is,the formal version of the cognitive assessment scale for advanced medical planning for patients with chronic diseases is formed.The formal scale consists of 24 items,named as knowledge perception,meaning perception,participation in medical decision-making,communication ability perception,support perception,and situation perception.(3)In confirmatory factor analysis,the factor structure of the scale is stable.After a correction,all model fitting indicators are within the ideal standard range,χ2/df<3,RMSEA value is less than 0.1,GFI,CFI,NFI,IFI values are all greater than 0.9,each standard path coefficient scale item is 0.759-0.951,The correlation coefficients between dimensions are 0.38-0.71.The internal structural validity of the scale is good,indicating that the six-factor structure of the official version of the scale is stable.The Cronbach’s alpha coefficient of the scale was 0.956,and the Cronbach’s alpha coefficient of each dimension was 0.896-0.939.3.Investigation on the factors influencing the cognition of advance care planning in patients with chronic diseasesThe cognitive of advance care planning score of 470 patients with chronic disease was82.16±17.93 points,which was in the middle level.Number of chronic diseases,duration of illness,pain in daily life,surgical experience,relatives who had a fatal illness or major accident,caring for dying relatives,participation in discussions about medical treatment to prolong family life.The difference was statistically significant(P<0.05);multiple linear regression analysis in model 5 showed that number of children,course of disease,health literacy,patient participation attitude,family intimacy and family adaptability were the had a significant influence factor on cognitive level of advance care planning for patients with chronic diseases(P<0.05).4.Evaluation of cognitive intervention effect of advance care planning for chronic disease patientsAll indicators before and after intervention in the two groups were significantly improved,and the difference was statistically significant(P<0.05).In the comparative analysis of the differences in the health outcomes of the two groups of subjects before and after the intervention,the total cognitive score of advance medical planning and knowledge cognition,meaning perception,communication ability,perceived support,situational awareness,advance medical planning degree and various dimensions,disease perception total score and disease cognition dimension,death anxiety total score and stress and pain dimension,time awareness dimension,disease self-management behavior total score and motor behavior dimension,communication behavior dimension with doctor,difference score between intervention group before and after intervention were significantly higher than the control group,the difference was statistically significant(P<0.05).Conclusion:1.The connotation of the cognition of the advance plan for patients with chronic diseases mainly includes the cognition of knowledge and concepts,the cognition of ability,and the cognition and judgment of the situation.The cognition of advance care planning in patients with chronic diseases has the characteristics of diversity and individuality,and the influencing factors are complex.2.The developed Cognition Scale of Advance Care Planning for Patients with Chronic Diseases is considered to be reliable and effective,and can be used to measure the awareness of advance medical planning in patients with chronic diseases.3.Apply and formulate an advance care planning cognitive assessment scale for chronic disease patients to measure the cognitive status of chronic disease patients in Yanji City on advance care planning,and to clarify its influencing factors.4.Accurately assess the cognition of patients through the cognitive assessment scale of advance care planning for chronic disease patients,based on the COM-B model framework,provide a cognitive intervention program for advanced care planning for chronic disease patients,and provide advanced medical services for chronic disease patients.Project cognition,preparation,psychological adaptation(illness perception,death anxiety)and disease management all contribute. |
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