A Study On Advance Care Planning For Patients With Mild Cognitive Impairment Based On Planned Behavior Theory

Objective: To explore the intention of patients with mild cognitive impairment to discuss advance care planning in the context of Chinese culture based on the theory of planned behavior,and to analyse the influencing factors,in order to provide the reference and theoretical foundation for prompting advance care planning among patients with mild cognitive impairment.Methods: Guided by the theory of planned behavior,an interview outline was designed,and eight elderly patients with mild cognitive impairment were chosen in the study.Date was collected by Individual semi-structured in-depth interviews.Colaizzi data analysis was used to analyze the data to obtain behavioral beliefs、normative beliefs and control beliefs.According to literature review and the qualitative interviews results,summarize the intention and influencing factors of advance care planning,use the theory of planned behavior as a framework to guide the design of the questionnaire,and revise the questionnaire based on expert consultation.With convenient sampling method,191 elderly people with mild cognitive impairment were surveyed by questionnaire.Statistics Package for Social Science(SPSS)21.0 software was used to perform descriptive analysis,independent sample t-test,one-way analysis of variance,correlation analysis and multiple linear regression to process the data.Results: 1.Through qualitative interviews,the behavioral beliefs of the elderly with mild cognitive impairment on advance care planning are conducive to maintaining the quality of life,and complying with self-will is conducive to family harmony,which is a manifestation of social progress;standardizing beliefs is to value the opinions of important others,hope to get the support of important others;control beliefs is lack of autonomy,lack of social environment for advance care planning,lack of propaganda and education.2.Based on these beliefs and literature,the questionnaire was constructed 17 items from 5 sub-questionnaires including subjective norm,Perceived behavioral control,external environmental factors,Intention.The Cronbach’s a coefficient was 0.928,all content validity of questionnaire items was 1 and the scale-level CVI was 1.3.After the t test,ANOVA and related analysis,the variables significantly related to the behavioral intentions of the advance care planning are: behavioral attitude,subjective norms,perceived behavioral control,external environmental factors,MCI cognition,ACP cognition,cultural level,and end-stage treatment Attitude,concept of life and death.However,age,gender,marital status,religion,and perceived health status are not factors that influencing the ACP’s willingness in the elderly with mild cognitive impairment.4.The multivariate regression analysis on the influence of ACP intention showed that perceived behavioral control,Attitude toward a behavior,and external environmental factors had significant effects on ACP intention,which explained 70.4 percent variation of ACP intention.Conclusion: 1.The questionnaire on intention and influencing Factors of MCI elderly advance care planning has good reliability and validity,which can effectively predict ACP behavioral intention,and can provide some reference for researchers in ACP field.2.Through the survey combined with Semi-structured individual interview,the results show that Elderly people with mild cognitive impairment have a positive subjective attitude towards ACP,and are willing to discuss ACP.But there are still many obstacles in the current social environment.3.There are many factors that affect the ACP willingness of the MCI elderly,the individual’s ACP cognition,education level,and life-and-death outlook all significantly affect the ACP’s willingness.Behavioral attitude and perceived behavioral control in Theory of Planned Behavior can significantly predict ACP intention.