Research On The Construction Of An Intervention Model For Advance Care Planning In Adolescent And Young Adult Cancer Patient

Objective: To establish an intervention program for Advance Care Planning(ACP)in adolescent and young adults(AYAs)cancer patients,providing a foundation for ACP practice within this population.Methods:(1)Literature Research: Conducted a search and analysis of literature from both Chinese and English databases to provide a reference basis for designing the intervention program.(2)Focus group interviews: Utilized purposive sampling to conduct three focus group interviews with 7 AYAs cancer patients,family members,and nurses each in a tertiary hospital.Explored patients’ and family members’ cognitions,attitudes,and needs regarding ACP from different perspectives,as well as nurses’ cognitions,attitudes,and suggestions for ACP intervention program.Data were organized and analyzed using NVivo Pro 12.0 software.(3)Semi-structured interviews: Employed purposive sampling to interview 15 AYAs cancer patients in a tertiary hospital,delving into their cognitions,attitudes,and needs regarding ACP.Utilized the Colaizzi’s 7-step analysis method to analyze the data,further enriching the content of the ACP intervention program.(4)Delphi method: Selected 15 experts who met the criteria to consult on the initial draft constructed based on the literature review,focus group interviews,and semi-structured interviews.The experts evaluated the importance and feasibility of each item.SPSS 26.0 software was used for data analysis.The selection criteria were set as an average score of importance or feasibility ≥3.5 and a coefficient of variation of importance or feasibility<0.25.The final ACP intervention program for AYAs cancer patients was formulated based on expert opinions and these criteria.Results:(1)Through systematic literature search and rigorous quality assessment,a total of 5articles were selected.The extracted information included intervention forms,intervention content,evaluation indicators and timing,intervention effects,and information related to the interveners.(2)Focus group interviews: The levels of awareness of ACP among patients,family members,and nurses need improvement.They lack knowledge about ACP and are influenced by the cultural environment.Attitudes toward ACP varied among patients,family members,and nurses,ranging from acceptance,and uncertainty,to non-acceptance.Patients and family members expressed needs in terms of information,communication,and decision-making.Nurses provided five suggestions for the ACP intervention model,including conducting education on life and death and ACP-related education,social and psychological assessment,building a bridge for doctor-patient communication,assisting in implementing ACP plans and improving legal mechanisms for protection.(3)Semi-structured interviews: 8 themes were identified regarding the awareness,attitudes,and needs of AYAs cancer patients about ACP.These themes included the influence of life and death in traditional Chinese culture and social customs,acceptance but lacking motivation and information to engage in ACP,uncertainty triggering death anxiety and fear,social and psychological support needs,information needs,peer support needs,life reflection and prospects,and the search for meaning in life.(4)An intervention program for ACP in AYAs cancer patients was constructed.The intervention program included 5 primary indicators,11 secondary indicators,and 40 tertiary indicators.The specific implementation steps encompassed intervention timing,intervention goals,intervention methods,and evaluation indicators.The participation rate of the experts was 100%,and the group authority coefficient of the expert group was 0.797.Kendall’s coefficient of concordance for the three-level indicators in the first round of expert consultation ranged from 0.172 to 0.370,while in the second round,it ranged from 0.238 to 0.394.The results of the chi-square test showed statistical significance(P<0.05),indicating an increased level of agreement among the expert opinions.The coefficient of variation for the importance and feasibility of each item was less than 0.25,indicating a relatively high level of consensus among the experts.Conclusion:(1)AYAs cancer patients,family members,and nurses have insufficient awareness of ACP,but the majority hold an accepting attitude,with only a few individuals expressing uncertainty or non-acceptance.During the process of engaging in ACP conversations,AYAs cancer patients and their family members expressed need for information,communication,and decision-making.This indicates the importance of promoting life and death education at the societal level and actively advocating the concept of ACP.At the same time,healthcare professionals should enhance patients’ motivation and confidence to participate in ACP,address their death anxiety,fear,and other emotions,and provide timely psychological counseling and support,ultimately helping patients find meaning and self-worth in their participation in ACP practice.(2)The constructed “Intervention program for Advance Care Planning in Adolescent and Young Adult Cancer Patients” includes 5 primary indicators,11 secondary indicators,and 40 tertiary indicators.The specific implementation steps encompass intervention timing,intervention goals,intervention methods,and evaluation indicators.This intervention program is necessary,scientifically grounded,reliable,pertinence,and holds significant practical significance.