Analysis Of The Readiness And Influence Factors Of Advance Care Planning For Patients With Esophageal Cancer

Background:Advance care planning(ACP)refers to a medical care measure in which a patient expresses his willingness to treat in the future when he loses the ability to make decisions when he is conscious and has normal behavior.ACP represents the humanitarian medical system that respects human nature and the law of life development,which has an important impact on the quality of life and death of cancer patients.Objectives:1.To describe the preparedness status of advance care planning for patients with esophageal cancer;2.To explore the influence of general demographic factors,disease characteristics,family support,and disease uncertainty on the ACP readiness of patients with esophageal cancer.Methods:Using cross-sectional research methods,from December 2019 to October 2020,a survey was conducted on patients with esophageal cancer who were hospitalized in the Department of Cardiothoracic Surgery,Oncology Department,and Palliative Medicine Center of a tertiary A general hospital in northeastern Sichuan.The survey tools include general information questionnaire,Chronic non-communicable diseases in patients with the readiness for advance care planning Questionnaire,The Edmonton Symptom Assessment Scale(ESAS),Chinese Mishel Uncertainty in Illness Scale for Adults(MUIS-A),Family Support Questionnaire(FSQ),Previous End of life Experiences Scale(PEES).The data were analyzed by SPSS 23.0 software.Statistical methods include descriptive analysis,non-parametric test,independent sample t test,analysis of variance,multiple linear stepwise regression analysis,etc.Result:1.The survey issued 330 questionnaires,and received 323 valid questionnaires;2.Descriptive statistical analysis results showed that:(1)The total score of ACP readiness for patients with esophageal cancer was between 45 and 110 points,with an average score of 81.70±15.69 points,and the entries are divided into 3.71±0.71 points.The average score of each dimension item is from high to low as ACP motivation(4.89±0.71 points),ACP beliefs(3.99±0.66 points),ACP attitudes(3.45±0.85).(2)The family support score of patients with esophageal cancer was 10.64±2.60,19 were low-level family supporters,accounting for 5.8%,112 were middle-level family supporters,accounting for 34.8%,and 192 were high-level family supporters,accounting for 59.4%;(3)The score of esophageal cancer disease uncertainty is 48.44±5.84 points,with moderate disease uncertainty being the main category(88.6%),of which the complexity dimension score is 29.92±4.91 points;the uncertainty dimension score is 48.44±5.84 points.3.The single factor analysis result showed that:(1)The correlation test between demographic characteristics and ACP shows that ACP readiness is related to the gender,religious beliefs,marital status,age,education level,family income,and medical insurance type of the research subjects,(P<0.05);disease characteristics are related to ACP The correlation test of ACP showed that the ACP readiness was related to the research object’s disease stage,course of disease,expected survival,recurrence or not,symptom severity of combined chronic diseases,end-stage medical experience,and whether they had been exposed to ACP related concepts before(P<0.05).(2)The total ACP readiness score,attitude dimension,belief dimension and motivation dimension of the research subjects were positively correlated with the level of family support(P<0.05).(3)The total disease uncertainty score of patients with esophageal cancer and its two-dimensional scores of complexity and ambiguity are significantly positively correlated with the total score of ACP readiness,attitude,belief,and motivation(P<0.01).4.The results of multiple linear stepwise analysis show that:(1)The influence factors of ACP readiness for patients with esophageal cancer include:suffering from a fatal disease or encountering a major accident,taking care of dying relatives,combining with other chronic diseases,expected survival,TNM stage,complexity,ambiguity,age,Together to explain 59.3%of the total variation.(2)The influence factors of the attitude dimension of ACP include having taken care of the dying relatives,combined with other chronic diseases,expected survival time,ambiguity,symptom score,which jointly explain 55.3%of the total variation.(3)The influence factors of the belief dimension of ACP include having suffered a fatal disease or a major accident,TNM stage,complexity,ACP understanding,and family support,which jointly explain54.2%of the total variation.(4)The influence factors of the ACP motivation dimension include religious beliefs,suffering from fatal diseases or major accidents,taking care of dying relatives,ambiguity,total family support score,and age,which jointly explain 55.2%of the total variation.Conclusion:1.The ACP readiness and all dimensions of patients with esophageal cancer are at the upper-moderate level.2.There is a correlation between the patient’s age,religious beliefs,severity of the disease and the patient’s past medical experience and ACP readiness.Therefore,during the process of ACP implementation,people with high sensitivity to ACP should be identified and actively intervened to improve the efficiency of ACP implementation.3.The lower the level of disease uncertainty and the higher the level of family support,the better the preparation for ACP.Therefore,before the implementation of ACP,we should provide patients with sufficient disease information and guide family members to provide more scientific support for patients,so as to improve the preparation of patients for ACP.