Investigation And Educational Intervention On The Acceptance Of Advance Care Planning For Elderly Patients With Chronic Diseases In The Community

Objectives(1)The aim was to investigate the Advance Care Planning(ACP)acceptance,self-perceived aging,benefit finding level and health status of community elderly chronic disease patients,and examine their differences in general conditions.(2)The aim was to understand the potential emotional status of elderly patients with chronic diseases in the community and guide them to properly vent their bad emotions.(3)The aim was to explore the relationship between ACP acceptance and perceived aging,benefit discovery level,and self-health.(4)The aim was to popularize the health management and ACP knowledge of common chronic diseases through educational intervention,teach the skills of self-counseling of bad emotions,help the elderly patients with chronic diseases in the community face up to physical and mental changes,clarify values,clarify medical preferences,encourage them to plan in advance,and improve the acceptance of ACP.(5)The aim was to supplement the information with a semi-structured interview to explore the perception and attitude towards ACP.Methods(1)Literature analysis.This study systematically combed the relevant literature of ACP at home and abroad to understand its research progress.(2)Questionnaire survey method.This study investigated ACP acceptance,aging attitude,benefit finding level,health status and mood status in 160 community elderly patients with chronic disease,with data processing using SPSS26.0.(3)Educational intervention law.This study conducted 30 community elderly patients with ACP acceptance educational intervention and examined the intervention effect.(4)Semi-structured interview method.This study interviewed three elderly patients with chronic diseases in the community to analyze their cognition and attitude towards ACP in disease and life research.Results(1)The attitude of community elderly patients with chronic diseases towards ACP was scored(33.71±7.78),belief(18.98±2.98),participation motivation(25.76±4.03),and total acceptance(78.44±13.35).The ACP acceptance level of elderly patients with chronic diseases differed significantly in age(F=6.920,p<0.01),education level(F=10.308,p<0.001),number of children(F=11.821,p<0.001),habitual residence(F=10.378,p<0.001),average monthly income(F=6.384,p<0.001),hospitalization experience(t=0.212,p<0.05),and medical payment method(F=6.242,p<0.01).(2)The overall score of self-perceived aging of elderly patients with chronic diseases in the community was(45.39±9.86),and the perception of self-aging was positive.The overall score of the benefit finding was(69.96±16.25),which was at the upper middle level;The health utility value was(0.86±0.19),and the self-rated health score was(78.65±11.81),both at the middle and upper levels.Eleven mood parameters except happiness were within the norm reference interval.The self-perceived aging,benefit discovery,and health status of elderly patients with chronic diseases in the community are related to their age,education level,marital status,habitual residence,average monthly income,type of chronic disease,length of illness,medical payment method,hospitalization experience and rescue experience.(3)Correlation analysis showed that ACP acceptance was somewhat associated with the level of benefit finding,self-perceived aging and health(p<0.001,p<0.001,p<0.01).Multiple linear regression analysis showed that the number of children,active control,personal growth,and health behavior change were predictive of ACP acceptance among elderly patients in the community(p<0.001,p<0.05,p<0.001,p<0.01).(4)After educational intervention,the ACP acceptance score was significantly higher than before the intervention(p<0.001);however,the intervention group scored significantly higher than the control group(p<0.001).Both self-perceived aging and benefit finding scores were significantly higher in the intervention group than before the intervention(p<0.001);there was no significant difference between the control group before and after the intervention(p>0.05).(5)The educational intervention program designed in this study helps the community elderly patients with chronic diseases to form a positive life attitude,clarify values,clarify personal medical preferences,and improve their ACP acceptance.Conclusions(1)The acceptance of ACP in elderly patients with chronic diseases in the community is at an upper moderately high level.Those aged 60 to 69,more educated,have fewer children,permanent residence in urban areas,higher average monthly income,hospitalization experience and full medical fees have higher levels of ACP acceptance.(2)The ACP acceptance of elderly patients with chronic diseases in the community is related to their level of benefit discovery,self-perceived aging,and their health status.Among them,positive control and emotional representation can negatively predict ACP acceptance,and spiritual growth,personal growth and health behavior changes can positively predict ACP acceptance.(3)The educational intervention program designed in this study can help older people improve their negative self-perceived aging,enhance their benefit discovery ability,and improve their ACP acceptance.