Construction Of The Dyadic Relationship Model For Influencing Factors Of Perception To "Advance Care Planning" Among Lung Cancer Patients And Caregivers

ObjectiveTo investigate the current status and influencing factors of cognition to ACP among lung cancer patients and their caregivers,and to explore the predictive effect and dual interaction of personality characteristics and death attitude on cognition to ACP,which would provide a theoretical basis for the development and implementation of ACP.Methods145pairs of lung cancer patients and primary caregivers were selected from a top three hospital in Jinan by means of convenient sampling from June to December 2019.The measurement include a general information questionnaire,Advance Care Planning Acceptance Questionnaire(ACPQ),Type D Personality Scale 14(DS14),Death Attitude Profile-Revised(DAPR),Quality of Life Scale for Cancer Patients-Lung Cancer Module(EORTC QLQ-LC13).AMOS 22.0 and SPSS 22.0 were used for data entry,sorting and analysis,descriptive statistical analysis was used to describe the general data and cognitive status of patients,and independent sample T-test,ANOVA and Pearson correlation analysis were applied to analyze the influencing factors of cognitive status.Multiple linear regression analysis and structural equation model path analysis were used to explore the interaction effect of the object of study.Results1.The cognition of lung cancer patients and caregivers to ACPThe overall scores of ACP cognition among patients with lung cancer were(57.68±10.16),and those of caregivers were(58.06±9.18).Both were under the medium level.Divorced or widowed,monthly family income were positively correlated with the cognitive scores of lung cancer patients.For caregivers,age,number of children,and presence of minor children were significantly correlated with cognitive level(p=0.005,p=0.045,p=0.004).2.Study subjects in the D personality,death attitude scores and differencesThe subjects included 100(34.5%)Type D personalities,including 50 cancer patients and 50 caregivers.The total score of death attitude of lung cancer patients was(90.43±18.40),and the total score of death attitude of caregivers was(93.59±18.30),In the correlation analysis,there was no significant difference in the total scores of D type personality and death attitude among the subjects(p>0.05).3.Binary interaction effect analysis of cognitive influencing factors of ACPAccording to the results of univariate analysis,fear(β=0.008,p=0.002)could positively predict the cognitive level of patients.Acceptance(β=-0.011,p=0.006)was a negative predictor of cognitive level.While fear of caregivers(β=0.005,p=0.050)were positive and negative predictors of their cognitive level.The cognitive score of caregivers was taken as the dependent variable.The results showed that fear(β=0.007,p=0.005)positively predicted the cognitive level of caregivers.While escape from acceptance(β=-0.008,p=0.019)was negatively predictive of cognitive performance.Then negative affectivity of the patients(β=0.006,p=0.043)was positive predictor of caregivers’ cognitive level.Conclusions1.The cognition of lung cancer patients and caregivers to ACP is at a medium low level.2.The death fear of lung cancer patients can positively predict their cognitive level,while acceptance can negatively predict their cognitive level.The death fear in caregivers positively predicted cognitive performance in patients with lung cancer.3.The fear of death positively predicted the cognitive level of caregivers of patients with lung cancer,while escape from acceptance negatively predicted their cognitive level.The negative affectivity of patients can positively predict the cognitive level of caregivers.4.There was a binary interaction between the negative affectivity and deathattitude of lung cancer patients and their caregivers and the cognition of pre-established medical care plan.