The Chinese Localization Of Advance Care Planning Questionnaire And The Application In Community Elderly People

Objectives1.To translate Advance Care Planning Questionnaire(ACPQ)into Chinese and to test the reliability and validity of the Chinese version of ACPQ in community elderly people;2.Investigate the status of awareness and attitude of ACP among community elderly people;3.To explore the factors affecting the attitude of ACP among community elderly people with the mixed-method.MethodsThis study consists of three parts.1.Translation and reliability and validity test of ACPQ.After obtaining the authorization of the original author,the ACPQ was translated into the Chinese version using FACIT.The ACPQ test version was formed through target group cognitive interviews,expert group meetings,and pre-investigation;The surface validity,content validity,construct validity,Cronbach's a coefficient,test-retest reliability,and split-half reliability of ACPQ among 514 community seniors were evaluated via SPSS.2.Mixed-method research(quantitative research part).523 community elders who met the inclusion criteria was selected from 4 communities of Zhengzhou and 1 communities of Huainan through the convenience sampling method.The status of cognition and attitude of ACP among respondents,as well as the influencing factors of their attitudes was investigated via the Chinese version of ACPQ;IBM SPSS 21.0 software was used for statistical description and analysis;Multiple linear regression analysis methods was adopted to determine the influencing factors of attitude of ACP among respondents.3.Mixed research(qualitative research part).Using phenomenological research methods,a semi-structured interview was conducted on 15 community elders who took different attitudes towards ACP,and the interview data was semantically analyzed using the Colaizzi 7-step analysis method.Result1.The correlation coefficient of the Chinese version of ACPQ is greater than 0.4(P<0.01);4 factors were extracted using exploratory factor analysis,which explained 69.17%of the total variation;Confirmatory factor analysis results showed that each factor was well loaded,?2/df=2.520,RMSEA=0.054,RMR=0.034,GFI=0.949,CFI=0.965,IFI=0.970;the Cronbach's a coefficient of the Chinese version of ACPQ is 0.841;the Cronbach's a coefficient of each dimension is 0.726 to 0.921,and the test-retest reliability is 0.730 to 0.884.2.The awareness of the terminology of ACP for the elderly in the community are as follow:ACP(4),end-of-life decision(51),living will(101),power of attorney(22),decision-making agent(0);the disease-related perception dimension score of the ACPQ is(11.413±4.03)points,the positive autonomy dimension is(9.56±2.21)points,the avoidance of death dimension is(7.36±1.54)points,the belief and destiny dimension is(14.13±1.83)points;The results of multiple linear regression analysis showed that self-assessment of health status,hospitalization experience,participation in treatment decision-making,death of relatives and friends or life-sustaining treatment experience are factors that affect the attitude of the community's elderly to ACP,37.90%of the total variation was explained.3.There are 6 themes for the reasons why the elderly in the community take different attitudes to the ACP:?reduction of physical or psychological pain,?the desire for "good death",?lack of correct understanding of ACP,?lack of life education,?lack of Supported by relevant policies and laws,? Traditional culture and emotions.Conclusion1.The Chinese version of ACPQ has valid reliability and validity,and can be used to investigate the status of ACP awareness and attitude of the elderly in communities.2.The elderly in the community shows a low level of ACP awareness and generally have a positive attitude towards ACP.Self-assessment of health status,hospitalization experience,experience in participating in treatment decision-making,encounter with relatives and friends passing away,and relatives and friends receiving life-sustaining treatment are influencing factors for the elderly in the community to adopt a positive attitude towards ACP.3.It is necessary to guide the ACP to adapt to my country's traditional culture,and on this basis,increase policy and legal support,and provide services that meet the standards in the community and other public environments to promote the development of palliative care in my country.