Study On The Readiness For The Advance Care Planning Of Advanced Cancer Patients And Its Influencing Factors

Background: The "advance care planing"(ACP)refers to the process whereby a patient,when conscious,has the behavioral ability to communicate with his/her family and health care personnel,and is unable to make a medical decision due to full consideration of the deterioration of his/her condition,establishes a pre-established medical care option and develops written instructions together.ACP emphasizes the empowerment of informed consent and self-determination,it helps ensure that terminally ill patients receive treatment and care consistent with their values and choices when they are unable to express their wishes.It has been carried out for a long time in developed countries and regions such as Britain and the United States,developed into a more mature system of intervention,and still be in starting stage at present in our country inland.In order to understand the feasibility of implementing ACP in advanced cancer patients,this study discussed the status quo and influencing factors of ACP readiness in advanced cancer patients.Objective: 1.Describe the status quo of ACP readiness in patients with advanced cancer,and explore its influencing factors;2.The reasons for the differences in ACP readiness level were explained from the perspective of positive psychology,so as to provide effective intervention measures to improve the ACP readiness level of patients with advanced cancer.Methods: Based on cognitive adaptation theory,with questionnaires of the readiness for advance care planning scale,Chinese meaning in life questionnaire(C-MLQ),revised life orientation test(LOT-R),benefit finding scale(BFS),multidimentional health locus of control(MHLC),self-esteem scale(SES)were used to investigate 355 patients with advanced cancer in oncology department of four third-class hospitals in Anhui province from November 2019 to May 2020,to explore the level of the readiness for advance care planning and its influencing factors.Mean and standard deviation were used to describe the level of ACP readiness in advanced cancer patients,and multiple linear regression analysis was used to determine the influencing factors.Results: 1.A total of 355 valid questionnaires were collected in this study.The total score of ACP readiness,attitude,belief and motivation of patients with advanced cancer was(76.00±10.08),(33.10±6.48),(17.82±2.76)and(25.08±4.03),respectively.2.Univariate analysis results showed that:there were differences in ACP readiness scores among patients with advanced cancer in age,education level,disease understanding degree and duration of disease(P<0.01,P<0.01,P<0.01,P<0.01).The results of correlation analysis showed that ACP readiness was significantly positively correlated with life meaning,benefit finding,optimism and self-esteem(life meaning:r=0.542,P<0.01;benefit finding:r=0.584,P<0.01;optimism:r=0.341,P<0.01;self-esteem:r=0.453,P<0.01).ACP readiness was significantly negatively correlated with opportunistic sense of control and Chinese traditional cultural belief(opportunistic sense of control:r=-0.185,P<0.01;Chinese traditional cultural belief :r=-0.361,P<0.01).3.The results of multiple linear regression analysis on the total score of ACP readiness showed that life meaning,benefit discovery and self-esteem were the influential factors of ACP readiness(life meaning: t=12.521,P<0.001;benefit finding: t=5.261,P<0.001;self-esteem: t=6.486,P<0.001).In addition,further subgroup analysis showed that benefit finding and education level were the two main factors affecting APC attitude dimension(benefit finding: t=2.725,P=0.008;education level: t=2.690,P=0.034),The meaning of life and the duration of disease were two factors affecting APC belief dimension(meaning of life: t=4.510,P<0.001;duration of disease: t=3.307,P=0.002),Meanings of life and duration of disease were also two factors affecting APC motivation(meaning of life: t=5.180,P<0.001;duration of disease: t=2.517,P=0.014).Conclusions: The ACP readiness of patients with advanced cancer is above the medium level.Patients with higher education,longer disease duration,sense of life meaning,benefit discovery,and high self-esteem were better prepared for ACP.Therefore,in future ACP implementation,these patients should be identified.At the same time,effective measures can be taken to improve the sense of life meaning,the level of benefit discovery and the level of self-esteem of patients with advanced cancer,so as to improve the level of ACP readiness of patients,actively provide objective support,and promote the clinical practice of ACP.