Acceptance level of advance care planning and its associated factors among the public: A nationwide survey

BMC Palliative Care Wang et al. BMC Palliative Care (2024) 23:201 https://doi.org/10.1186/s12904-024-01533-0 Open Access RESEARCH Acceptance level of advance care planning and its associated factors among the public: A nationwide survey Xue Wang1† , Yibo Wu2† , Xinghua Bai3 , Qiao Qiao3 , Ling Yu4 , Lina Ge5 , Li Qi6 and Shuang Zang1* Abstract Background Advance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model. Methods A total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP. Results On a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00–83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP. Conclusions This study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges. Keywords Advance care planning, Adults, Socioecological model, China, National survey † Xue Wang, Yibo Wu these authors share the first authorship on this work. *Correspondence: Shuang Zang 1 Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang 110122, Liaoning Province, China 2 School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing 100191, China 3 Department of Radiation Oncology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang 110001, Liaoning Province, China 4 Phase I Clinical Trails Center, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang 110001, Liaoning Province, China 5 Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping Area, Shenyang 110004, Liaoning Province, China 6 School of Nursing, Qiqihar Medical University, No.333, Bukui North Street, Jianhua District, Qiqihar City 161006, Heilongjiang Province, China © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it.The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.To view a copy of this licence, visit http:// creativecommons.org/licenses/by-nc-nd/4.0/. Wang et al. BMC Palliative Care (2024) 23:201 Introduction Advance care planning (ACP) refers to the process by which competent adults of any age and health status make advance decisions about their future end-of-life medical care preferences based on their circumstances and document and share these preferences with family members and healthcare providers [1]. ACP has gained increasing recognition worldwide as an important strategy to improve end-of-life care quality and people-oriented outcomes [2, 3]. Despite this recognition, ACP remains less widely popularized in many countries, including China [4]. China has the world’s largest population and is experiencing a rapid aging process, which raises concerns about the quality of end-of-life care for older adults [5]. There have been some studies on participating and accepting ACP in Western countries. For example, a general population survey in Norway showed that more than nine out of ten people from 1035 responses wanted to participate in ACP [6]. A study on the residents of nursing homes in the United Kingdom found that about 79.5% of the participants chose ACP [7]. The research in China has been primarily focused on subpopulations, such as community healthcare workers [8], patients with chronic diseases [9], and cancer patients [10]. None of the existing studies have investigated the acceptance level of ACP among the public across China. As the completion of ACP relies on improved public awareness and greater openness to discuss death and end-of-life care [11], it is crucial to gain an understanding of the factors associated with ACP acceptance among the public. The socioecological model provides a theoretical framework for comprehensively elucidating the intricate interconnections among individual characteristics, behaviors, interpersonal networks, community, and policy levels [12]. The socioecological model has been extensively applied in research to explore healthrelated attitudes and underlying determinants within a multidimensional framework [13–15]. In our research, we embrace the socioecological model as a theoretical framework to probe the acceptance level of ACP within the Chinese context. Therefore, the purpose of this study is to explore the acceptance level of ACP and its associated factors based on the socioecological model among the public in China, providing important insights to improve end-of-life care in China. Methods Survey design and population Between June 20 and August 31, 2022, a survey was carried out in 31 provinces, autonomous regions, special administrative regions, and municipalities in China. The survey employed a multistage sampling approach, based Page 2 of 11 on the quota attr (...truncated)