Investigation And Educational Intervention Study On The Acceptance Of Advance Care Planning For Elderly Patients

Objectives(1)To understand the status of ACP acceptance,physical health perception,values and death attitudes of elderly patients,and to investigate their differences in general conditions such as ages,genders and religious beliefs.(2)To explore the relationship between ACP acceptance and physical health perception,values and death attitudes.(3)Through educational intervention,introduce aging,disease,death and ACP related knowledge to elderly patients,strengthen their understanding physical and psychological changes,and help them clarify their values,so that elderly patients can face death more calmly,and improve their ACP acceptance.(4)Through semi-structured interviews,the understanding of ACP related variables in elderly patients was deeply explored.Methods(1)Firstly,through the literature analysis method,a large number of domestic and foreign ACP research literature were systematically analyzed to understand the development of ACP;Secondly,174 elderly patients were selected as the research objects,through the questionnaire survey,to investigated the status and influencing factors of ACP acceptance,physical health perception,values and death attitudes of elderly patients;Thirdly,the method of educational intervention was used to carry out ACP educational intervention for elderly patients and to test the effect of intervention;Finally,through semi-structured interviews,the attitudes of elderly patients towards disease,death and ACP were deeply explored.(2)SPSS 22.0 was used for statistical analysis of the questionnaire data.Results(1)The overall score of ACP acceptance in elderly patients was(3.44±0.53).There were significant differences in ACP acceptance in age(F=4.92,p<0.01),education level(F=15.604,p<0.001),residence(F=8.173,p<0.001),visit frequency of children(F=12.977,p<0.05),income(F=12.237,p<0.001),rescue experience(t=-2.376,p<0.05),whether they had lived in ICU(t=2.283,p<0.05),payment method(F=4.766,p<0.01)and whether they had heard of ACP(t=7.311,p<0.001).(2)The overall score of the elderly patients’ physical health perception is(3.14±0.40).The top two values are self-discipline and practical ability.The top two death attitude are natural acceptance and death escape.The health perception,values and death attitude of elderly patients are related to their gender,age,education level,income,disease type,payment method and treatment intention.(3)Through multiple linear regression analysis,it was found that the variables that could predict the acceptance of ACP in elderly patients included: education level(p<0.01),children visit frequency(p<0.01),whether they had lived in ICU(p<0.01),whether they had heard of ACP(p<0.001),public interest(p<0.01),and escape from death(p<0.001).(4)After education intervention,in terms of death attitude,the intervention group’s natural acceptance was significantly higher than before(p<0.05),and other dimensions were significantly lower than before(p<0.05);in the control group,there was no significant difference in all dimensions before and after intervention(p>0.05).In terms of ACP acceptance,the intervention group’s in all dimensions and total scores were significantly higher than before(p<0.05);in the control group,the dimension of ACP intention were significantly higher than before(p<0.01),in the other dimensions and the total scores of ACP acceptance,there was no significant difference before and after intervention(p>0.05).(5)After an in-depth interview with the elderly patients in the intervention group,it was found that the education intervention can help the elderly to calmly face aging,disease and death,clarify their values,improve their awareness of ACP,and enhance their acceptance of ACP.Conclusions(1)Elderly patients have a low awareness of ACP,but their acceptance level is acceptable.Male,over 70 years old,living in the city,higher education,higher monthly income,lower frequency of children’s visits,payment of public medical treatment,experience of rescue,admission to ICU,and heard of ACP in elderly patients have higher acceptance of ACP.(2)ACP acceptance of elderly patients is related to their perception of health,values and attitudes towards death.Public interest can positively predict ACP acceptance,death avoidance can negatively predict ACP acceptance.(3)The educational intervention of ACP for elderly patients can help them understand the knowledge of ACP and improve their acceptance of ACP,which has effect.