
上海交通大学学报(医学版) ›› 2024, Vol. 44 ›› Issue (4): 482-493.doi: 10.3969/j.issn.1674-8115.2024.04.009
傅艺玲(
), 吴茜, 罗晓庆, 吴艾泓, 夏雪兰, 郑敏(
)
收稿日期:2023-11-01
接受日期:2024-02-06
出版日期:2024-04-28
发布日期:2024-04-28
通讯作者:
郑 敏(1979—),电子信箱:1287285766@qq.com。作者简介:傅艺玲(1999—),女,护士,硕士生;电子信箱:1715757154@qq.com。
FU Yiling(
), WU Qian, LUO Xiaoqing, WU Aihong, XIA Xuelan, ZHENG Min(
)
Received:2023-11-01
Accepted:2024-02-06
Online:2024-04-28
Published:2024-04-28
Contact:
ZHENG Min, E-mail: 1287285766@qq.com.摘要:
目的·系统整合晚期癌症患者预立医疗照护计划(advance care planning,ACP)参与行为的相关影响因素。方法·系统检索中国知网、万方、中国生物医学文献数据库(Sinomed)、PubMed、Cochrane Library、Embase、CINAHL、PsycINFO等数据库从建库至2022年12月有关晚期癌症患者ACP参与行为影响因素的中英文文献。由2名研究者对最终纳入的文献进行文献质量评价、内容提取和汇总,将定量研究与定性研究分别提取数据后进行整合,得到晚期癌症患者ACP参与行为的最终影响因素。并借助理论域框架,将其逐级映射至能力、机会、动机-行为(capability, opportunity, motivation-behavior,COM-B)模型。结果·共纳入21项研究,整合归纳出27个影响因素,涉及9个理论域。映射至COM-B模型中的因素包括能力因素9个(ACP知识、文化程度、准确了解预后知识、知晓疾病诊断时间、先前经历、主观预期寿命、年龄、肿瘤部位、疾病症状负担)、机会因素13个(性别、婚姻状况、种族/民族、宗教信仰、未成年子女、家庭经济收入、居住地点、房屋居住类型、家庭支持、社会支持、医患关系、文化适应、是否设立临终关怀服务中心)和动机因素5个(ACP态度、ACP信念、ACP动机、焦虑抑郁、死亡态度)。其中,医患关系、宗教信仰、ACP态度、文化程度、婚姻状况、家庭支持、ACP知识、准确了解预后知识、年龄、居住地点、死亡态度、先前经历、种族/民族是对患者ACP参与行为影响较多的因素。结论·基于COM-B模型可全面归纳总结晚期癌症患者ACP参与行为的影响因素。未来研究可以上述因素为切入点,基于COM-B模型设计连续化、多方面的综合性干预措施,促进晚期癌症患者ACP参与行为实践。
中图分类号:
傅艺玲, 吴茜, 罗晓庆, 吴艾泓, 夏雪兰, 郑敏. 晚期癌症患者预立医疗照护计划参与行为影响因素的系统综述[J]. 上海交通大学学报(医学版), 2024, 44(4): 482-493.
FU Yiling, WU Qian, LUO Xiaoqing, WU Aihong, XIA Xuelan, ZHENG Min. Factors influencing advance care planning engagement behavior in patients with advanced cancer: a systematic review[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(4): 482-493.
| Step | Strategy |
|---|---|
| #1 | "advance care planning" [MeSH Terms] |
| #2 | "advance care planning" [Title/Abstract] OR "advance directives" [Title/Abstract] OR "living wills" [Title/Abstract]) OR "medical power of attorney" [Title/Abstract] |
| #3 | #1 OR #2 |
| #4 | "terminal" [Title/Abstract] OR "advanced" [Title/Abstract] OR "end-stage" [Title/Abstract] OR "end-of-life" [Title/Abstract] |
| #5 | "neoplasms" [MeSH Terms] |
| #6 | "neoplasms" [Title/Abstract] OR "cancer"[Title/Abstract] OR "tumor" [Title/Abstract] OR "oncology" [Title/Abstract] OR "malignancy" [Title/Abstract] |
| #7 | #5 OR #6 |
| #8 | #4 AND #7 |
| #9 | #3 AND #8 |
表1 PubMed 检索策略
Tab 1 Searching strategy for searching in PubMed
| Step | Strategy |
|---|---|
| #1 | "advance care planning" [MeSH Terms] |
| #2 | "advance care planning" [Title/Abstract] OR "advance directives" [Title/Abstract] OR "living wills" [Title/Abstract]) OR "medical power of attorney" [Title/Abstract] |
| #3 | #1 OR #2 |
| #4 | "terminal" [Title/Abstract] OR "advanced" [Title/Abstract] OR "end-stage" [Title/Abstract] OR "end-of-life" [Title/Abstract] |
| #5 | "neoplasms" [MeSH Terms] |
| #6 | "neoplasms" [Title/Abstract] OR "cancer"[Title/Abstract] OR "tumor" [Title/Abstract] OR "oncology" [Title/Abstract] OR "malignancy" [Title/Abstract] |
| #7 | #5 OR #6 |
| #8 | #4 AND #7 |
| #9 | #3 AND #8 |
| Author | Year | Area | Design | Research method | Sample size | Influencing factor | Quality rating |
|---|---|---|---|---|---|---|---|
| QU X L, et al | 2020 | Beijing, China | Qualitative study | Phenomenological study | 17 | Ⅰ: ①② | 80% |
| BAR-SELA G, et al | 2021 | Israel | Mixed studies | Phenomenological study Questionnaire investigation | 109 | Ⅰ: ①②⑧⑨⑩⑪ Ⅱ: ⑥⑦ | QN: 73% QL: 80% |
| WANG Y X, et al | 2019 | Hefei, China | Cross-sectional study | Questionnaire investigation | 520 | Ⅰ: ⑧⑨ Ⅱ: ④⑤⑥⑦⑫ ⑭⑮ | 64% |
| WANG L, et al | 2021 | Xi'an, China | Cross-sectional study | Questionnaire investigation | 72 | Ⅱ: ③⑤⑭⑯17 Ⅲ: 18 | 91% |
| YAN C X, et al | 2022 | Tianjin, China | Cross-sectional study | Questionnaire investigation | 206 | Ⅰ: ① Ⅲ: ②④⑭ | 86% |
| CHEN Y Z, et al | 2022 | Guangzhou, China | Cross-sectional study | Questionnaire investigation | 120 | Ⅲ: ③④⑪19 | 86% |
| TANG S T, et al | 2014 | Taiwan, China | Cross-sectional study | Questionnaire investigation | 2 450 | Ⅲ: ⑭2021 | 86% |
| WONG S Y, et al | 2012 | Hong Kong, China | Cohort study | Questionnaire investigation | 191 | Ⅲ: 20 Ⅳ: ⑩ | 77% |
| HOU X T, et al | 2021 | Beijing, China | Cross-sectional study | Questionnaire investigation | 264 | Ⅲ: ⑤⑥⑫⑬ | 73% |
| KIERNER K A, et al | 2010 | Austria | Cohort study | Questionnaire investigation | 108 | Ⅱ: 22 | 64% |
| RODENBACH R A, et al | 2021 | America | Cross-sectional study | Questionnaire investigation | 672 | Ⅲ: 19 | 86% |
| GARRIDO M M, et al | 2014 | America | Cross-sectional study | Questionnaire investigation | 606 | Ⅲ: 23 | 82% |
| NILSSON M E, et al | 2009 | America | Cohort study | Questionnaire investigation | 668 | Ⅲ: 24 | 86% |
| TRUE G, et al | 2005 | America | Longitudinal study | Questionnaire investigation | 68 | Ⅲ: ④23 | 73% |
| YOO S H, et al | 2020 | South Korea | Cohort study | Questionnaire investigation | 150 | Ⅰ: 25 Ⅳ: 20 | 86% |
| BROWN A J, et al | 2016 | America | Cross-sectional study | Questionnaire investigation | 110 | Ⅲ: ③⑥1926 | 77% |
| ZHU M L, et al | 2019 | Zunyi, China | Cross-sectional study | Questionnaire investigation | 90 | Ⅱ: ③⑯ | 59% |
| WANG Y L | 2021 | Shandong, China | Cross-sectional study | Questionnaire investigation | 145 | Ⅲ: ⑬⑭19 | 91% |
| SHEN M J, et al | 2018 | America | Cohort study | Questionnaire investigation | 279 | Ⅲ: 20 | 77% |
| SHEN M J, et al | 2020 | America | Qualitative study | Phenomenological study | 20 | Ⅰ: ④⑩⑪1823 | 55% |
| JIA Z M, et al | 2022 | America | Qualitative study | Phenomenological study | 21 | Ⅰ: ②⑪27 | 90% |
表2 纳入文献的基本特征
Tab 2 Characteristics of the included literature
| Author | Year | Area | Design | Research method | Sample size | Influencing factor | Quality rating |
|---|---|---|---|---|---|---|---|
| QU X L, et al | 2020 | Beijing, China | Qualitative study | Phenomenological study | 17 | Ⅰ: ①② | 80% |
| BAR-SELA G, et al | 2021 | Israel | Mixed studies | Phenomenological study Questionnaire investigation | 109 | Ⅰ: ①②⑧⑨⑩⑪ Ⅱ: ⑥⑦ | QN: 73% QL: 80% |
| WANG Y X, et al | 2019 | Hefei, China | Cross-sectional study | Questionnaire investigation | 520 | Ⅰ: ⑧⑨ Ⅱ: ④⑤⑥⑦⑫ ⑭⑮ | 64% |
| WANG L, et al | 2021 | Xi'an, China | Cross-sectional study | Questionnaire investigation | 72 | Ⅱ: ③⑤⑭⑯17 Ⅲ: 18 | 91% |
| YAN C X, et al | 2022 | Tianjin, China | Cross-sectional study | Questionnaire investigation | 206 | Ⅰ: ① Ⅲ: ②④⑭ | 86% |
| CHEN Y Z, et al | 2022 | Guangzhou, China | Cross-sectional study | Questionnaire investigation | 120 | Ⅲ: ③④⑪19 | 86% |
| TANG S T, et al | 2014 | Taiwan, China | Cross-sectional study | Questionnaire investigation | 2 450 | Ⅲ: ⑭2021 | 86% |
| WONG S Y, et al | 2012 | Hong Kong, China | Cohort study | Questionnaire investigation | 191 | Ⅲ: 20 Ⅳ: ⑩ | 77% |
| HOU X T, et al | 2021 | Beijing, China | Cross-sectional study | Questionnaire investigation | 264 | Ⅲ: ⑤⑥⑫⑬ | 73% |
| KIERNER K A, et al | 2010 | Austria | Cohort study | Questionnaire investigation | 108 | Ⅱ: 22 | 64% |
| RODENBACH R A, et al | 2021 | America | Cross-sectional study | Questionnaire investigation | 672 | Ⅲ: 19 | 86% |
| GARRIDO M M, et al | 2014 | America | Cross-sectional study | Questionnaire investigation | 606 | Ⅲ: 23 | 82% |
| NILSSON M E, et al | 2009 | America | Cohort study | Questionnaire investigation | 668 | Ⅲ: 24 | 86% |
| TRUE G, et al | 2005 | America | Longitudinal study | Questionnaire investigation | 68 | Ⅲ: ④23 | 73% |
| YOO S H, et al | 2020 | South Korea | Cohort study | Questionnaire investigation | 150 | Ⅰ: 25 Ⅳ: 20 | 86% |
| BROWN A J, et al | 2016 | America | Cross-sectional study | Questionnaire investigation | 110 | Ⅲ: ③⑥1926 | 77% |
| ZHU M L, et al | 2019 | Zunyi, China | Cross-sectional study | Questionnaire investigation | 90 | Ⅱ: ③⑯ | 59% |
| WANG Y L | 2021 | Shandong, China | Cross-sectional study | Questionnaire investigation | 145 | Ⅲ: ⑬⑭19 | 91% |
| SHEN M J, et al | 2018 | America | Cohort study | Questionnaire investigation | 279 | Ⅲ: 20 | 77% |
| SHEN M J, et al | 2020 | America | Qualitative study | Phenomenological study | 20 | Ⅰ: ④⑩⑪1823 | 55% |
| JIA Z M, et al | 2022 | America | Qualitative study | Phenomenological study | 21 | Ⅰ: ②⑪27 | 90% |
COM-B component | TDF | Original definition | Application of TDF to the connotation of ACP engagement behavior in patients with advanced cancer |
|---|---|---|---|
| Capability | |||
| Psychological capability | Knowledge | An awareness of the existence of something | Understanding and being familiar with ACP-related knowledge |
| Memory, attention and decision processes | The ability to retain information, selectively focus on aspects of the environment and choose between two or more alternatives | Ability to remember, focus, and select ACP | |
| Behavioural regulation | Anything aiming at managing or changing objectively observed or measured actions | Using healthy behaviors to manage emotions and pursue goals | |
| Physical capability | Skills | An ability or proficiency acquired through practice | Acquiring the ability or skill to engage in ACP through practice, including physiological and cognitive skills |
| Opportunity | |||
| Social opportunity | Social influences | Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviors | The process of social activities that enable individuals to change their cognition and behavior about ACP |
| Physical opportunity | Environmental context and resources | Any circumstance of a person's situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behavior | Personal conditions and environments that influence ACP engagement |
| Motivation | |||
| Reflective motivation | Beliefs about capabilities | Acceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive use | Believing that individuals have enough knowledge about ACP and can participate in ACP discussions |
| Goals | Mental representations of outcomes or end states that an individual wants to achieve | The psychological outcomes that individuals want to achieve | |
| Intentions | A conscious decision to perform a behavior or a resolve to act in a certain way | Identifying the skills that are needed to engage in ACP | |
| Beliefs about consequences | Acceptance of the truth, reality, or validity about outcomes of a behavior in a given situation | The degree to which the individuals accept the facts or believe that ACP's involvement in the behavior will lead to specific results | |
| Automatic motivation | Social/professional role and identity | A coherent set of behaviors and displayed personal qualities of an individual in a social or work setting | Self-perception based on social or professional identity |
| Optimism | The confidence that things will happen for the best or that desired goals will be attained | Confidence that the desired goal will be achieved | |
| Reinforcement | Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus | Promoting and strengthening support for ACP participation | |
| Emotion | A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event | A mental state or emotional response that is determined by an individual's environment |
表3 COM-B模型应用于晚期癌症患者ACP参与行为的内涵
Tab 3 Connotation of the COM-B model in the ACP engagement behavior of advanced cancer patients
COM-B component | TDF | Original definition | Application of TDF to the connotation of ACP engagement behavior in patients with advanced cancer |
|---|---|---|---|
| Capability | |||
| Psychological capability | Knowledge | An awareness of the existence of something | Understanding and being familiar with ACP-related knowledge |
| Memory, attention and decision processes | The ability to retain information, selectively focus on aspects of the environment and choose between two or more alternatives | Ability to remember, focus, and select ACP | |
| Behavioural regulation | Anything aiming at managing or changing objectively observed or measured actions | Using healthy behaviors to manage emotions and pursue goals | |
| Physical capability | Skills | An ability or proficiency acquired through practice | Acquiring the ability or skill to engage in ACP through practice, including physiological and cognitive skills |
| Opportunity | |||
| Social opportunity | Social influences | Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviors | The process of social activities that enable individuals to change their cognition and behavior about ACP |
| Physical opportunity | Environmental context and resources | Any circumstance of a person's situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behavior | Personal conditions and environments that influence ACP engagement |
| Motivation | |||
| Reflective motivation | Beliefs about capabilities | Acceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive use | Believing that individuals have enough knowledge about ACP and can participate in ACP discussions |
| Goals | Mental representations of outcomes or end states that an individual wants to achieve | The psychological outcomes that individuals want to achieve | |
| Intentions | A conscious decision to perform a behavior or a resolve to act in a certain way | Identifying the skills that are needed to engage in ACP | |
| Beliefs about consequences | Acceptance of the truth, reality, or validity about outcomes of a behavior in a given situation | The degree to which the individuals accept the facts or believe that ACP's involvement in the behavior will lead to specific results | |
| Automatic motivation | Social/professional role and identity | A coherent set of behaviors and displayed personal qualities of an individual in a social or work setting | Self-perception based on social or professional identity |
| Optimism | The confidence that things will happen for the best or that desired goals will be attained | Confidence that the desired goal will be achieved | |
| Reinforcement | Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus | Promoting and strengthening support for ACP participation | |
| Emotion | A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event | A mental state or emotional response that is determined by an individual's environment |
| COM-B | TDF | Influencing factor | Specific description |
|---|---|---|---|
| Capability | |||
| Psychological capability | Knowledge | Knowledge of ACP | →Getting more information about ACP can help patients to understand its significance[ →Patients do not know, do not understand or misunderstand the related concepts of ACP[ |
| Education level | →Cultural education can help patients engage in discussion APC[ | ||
| Behavioural regulation | Prior experience | →Patients with disease experience are more likely to discuss ACP[ | |
| Physical capability | Skills | Cancer site | →Lung cancer patients are more likely to complete advanced directives/Durable Power of Attorney (DPOA) than brain cancer patients[ |
| Opportunity | |||
| Social opportunity | Social influences | Race/ethnicity | →Hispanic patients prefer a family-centered, physician-informed approach to discussing ACP with consideration and incorporation of their religious medical beliefs about end-of-life care[ |
| Religious belief | →Overly optimistic religious beliefs will affect patients' discussion about ACP[ | ||
| Family support | →Patients hope to have open communication with family members[ →Involving family in conversations about end-of-life care can help Latinos to communicate[ →No close relatives agree to take responsibility for preventing patients from engaging in ACP[ →No close relatives can be trusted for preventing patients from engaging in ACP[ | ||
| Doctor-patient relationship | →Patients prefer for the trusted doctors to initiate ACP conversations[ →Patients hope to have open communication with physician[ →Patients' preconceived notions of clinicians' professional responsibility may hinder public discussion of future health care goals and values[ | ||
| Social support | →Providing culturally counseling services and educational materials can help patients learn how to communicate information about ACP[ | ||
| Acculturation | →A key regulator of how patients view ACP is their cultural adaptation to local norms of care, behavior, and communication[ | ||
| Physical opportunity | Environmental context and resources | Place of living | →Living in rural areas has a positive impact on patients' willingness to participate in ACP[ |
| Motivation | |||
| Reflective motivation | Intentions | ACP attitude | →Uncertainty about the timing of patients' engagement in ACP[ →Patients believe that engagement in ACP increases negative emotions[ →Patients question whether ACP itself can be carried out smoothly[ →Patients' belief in an uncertain future may hinder public discussion of future health care goals and values[ |
| Goals | ACP belief | →Patients hope to make the best medical decisions and avoid unnecessary medical measures[ | |
| Beliefs about capabilities | ACP motivation | →Having the opportunity to discuss disease information openly with families and doctors will increase patients' willingness to engage in ACP[ |
表4 定性研究影响因素的整合结果
Tab 4 Integration results of qualitative study of influencing factors
| COM-B | TDF | Influencing factor | Specific description |
|---|---|---|---|
| Capability | |||
| Psychological capability | Knowledge | Knowledge of ACP | →Getting more information about ACP can help patients to understand its significance[ →Patients do not know, do not understand or misunderstand the related concepts of ACP[ |
| Education level | →Cultural education can help patients engage in discussion APC[ | ||
| Behavioural regulation | Prior experience | →Patients with disease experience are more likely to discuss ACP[ | |
| Physical capability | Skills | Cancer site | →Lung cancer patients are more likely to complete advanced directives/Durable Power of Attorney (DPOA) than brain cancer patients[ |
| Opportunity | |||
| Social opportunity | Social influences | Race/ethnicity | →Hispanic patients prefer a family-centered, physician-informed approach to discussing ACP with consideration and incorporation of their religious medical beliefs about end-of-life care[ |
| Religious belief | →Overly optimistic religious beliefs will affect patients' discussion about ACP[ | ||
| Family support | →Patients hope to have open communication with family members[ →Involving family in conversations about end-of-life care can help Latinos to communicate[ →No close relatives agree to take responsibility for preventing patients from engaging in ACP[ →No close relatives can be trusted for preventing patients from engaging in ACP[ | ||
| Doctor-patient relationship | →Patients prefer for the trusted doctors to initiate ACP conversations[ →Patients hope to have open communication with physician[ →Patients' preconceived notions of clinicians' professional responsibility may hinder public discussion of future health care goals and values[ | ||
| Social support | →Providing culturally counseling services and educational materials can help patients learn how to communicate information about ACP[ | ||
| Acculturation | →A key regulator of how patients view ACP is their cultural adaptation to local norms of care, behavior, and communication[ | ||
| Physical opportunity | Environmental context and resources | Place of living | →Living in rural areas has a positive impact on patients' willingness to participate in ACP[ |
| Motivation | |||
| Reflective motivation | Intentions | ACP attitude | →Uncertainty about the timing of patients' engagement in ACP[ →Patients believe that engagement in ACP increases negative emotions[ →Patients question whether ACP itself can be carried out smoothly[ →Patients' belief in an uncertain future may hinder public discussion of future health care goals and values[ |
| Goals | ACP belief | →Patients hope to make the best medical decisions and avoid unnecessary medical measures[ | |
| Beliefs about capabilities | ACP motivation | →Having the opportunity to discuss disease information openly with families and doctors will increase patients' willingness to engage in ACP[ |
| COM-B | TDF | Influencing factor | Specific description |
|---|---|---|---|
| Capability | |||
| Psychological capability | Knowledge | Knowledge of ACP | →The percentage of patients willing to engage in ACP increased after understanding the concept, process, and importance of advance directive[ |
| Behavioural regulation | Knowledge of the time of disease diagnosis | →Patients who know about the diagnosis of the disease for longer are more likely to engage in ACP[ | |
| Subjective life expectancy | →Patients who are expected to live only a few months are less likely to prefer aggressive treatment[ | ||
| Physical capability | Skills | Disease symptom burden | →The greater the burden of symptoms, the less likely patients are to sign advance directives or health care powers of attorney[ |
| Opportunity | |||
| Social opportunity | Social influences | Family support | →Family members not objecting is an important factor in discussing ACP[ |
| Social support | →Patients with higher social support are more willing to engage in ACP[ | ||
| Doctor-patient relationship | →Poor doctor-patient relationship leads to low acceptance of ACP[ | ||
| Dependent children | →Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[ | ||
| Physical opportunity | Environmental context and resources | Housing type | →Patients without private housing are more willing to engage in ACP[ |
| Hospice service center | →Whether or not to establish a hospice service center is a factor influencing whether or not patients choose to participate in ACP[ | ||
| Motivation | |||
| Reflective motivation | Intentions | ACP attitude | →The sense of life meaning is the main factor influencing patients' attitude towards ACP[ |
| Goals | ACP belief | →Patients want to ensure a comfortable end-of-life and avoid pain[ | |
| Beliefs about capabilities | ACP motivation | →The reason that hinders patients from engaging in ACP is that patients think that their relatives can make decisions for them or that their wishes may change in the future[ | |
| Automatic motivation | Emotion | Anxiety and depression | →Patients who participated in ACP had significantly higher anxiety and depression scores than those who did not participate in ACP[ |
表5 定量研究描述性分析结果
Tab 5 Descriptive analysis results of quantitative study
| COM-B | TDF | Influencing factor | Specific description |
|---|---|---|---|
| Capability | |||
| Psychological capability | Knowledge | Knowledge of ACP | →The percentage of patients willing to engage in ACP increased after understanding the concept, process, and importance of advance directive[ |
| Behavioural regulation | Knowledge of the time of disease diagnosis | →Patients who know about the diagnosis of the disease for longer are more likely to engage in ACP[ | |
| Subjective life expectancy | →Patients who are expected to live only a few months are less likely to prefer aggressive treatment[ | ||
| Physical capability | Skills | Disease symptom burden | →The greater the burden of symptoms, the less likely patients are to sign advance directives or health care powers of attorney[ |
| Opportunity | |||
| Social opportunity | Social influences | Family support | →Family members not objecting is an important factor in discussing ACP[ |
| Social support | →Patients with higher social support are more willing to engage in ACP[ | ||
| Doctor-patient relationship | →Poor doctor-patient relationship leads to low acceptance of ACP[ | ||
| Dependent children | →Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[ | ||
| Physical opportunity | Environmental context and resources | Housing type | →Patients without private housing are more willing to engage in ACP[ |
| Hospice service center | →Whether or not to establish a hospice service center is a factor influencing whether or not patients choose to participate in ACP[ | ||
| Motivation | |||
| Reflective motivation | Intentions | ACP attitude | →The sense of life meaning is the main factor influencing patients' attitude towards ACP[ |
| Goals | ACP belief | →Patients want to ensure a comfortable end-of-life and avoid pain[ | |
| Beliefs about capabilities | ACP motivation | →The reason that hinders patients from engaging in ACP is that patients think that their relatives can make decisions for them or that their wishes may change in the future[ | |
| Automatic motivation | Emotion | Anxiety and depression | →Patients who participated in ACP had significantly higher anxiety and depression scores than those who did not participate in ACP[ |
| COM-B | TDF | Facilitator | Barrier |
|---|---|---|---|
| Capability | |||
| Psychological capability | Knowledge | Knowledge of ACP[ Education level[ Accurate knowledge of prognosis[ | Knowledge of ACP[ |
| Behavioural regulation | Knowledge of the time of disease diagnosis[ Prior experience[ | Subjective life expectancy[ | |
| Physical capability | Skills | Age[ Cancer site[ | Disease symptom burden[ |
| Opportunity | |||
| Social opportunity | Social influences | Marital status[ Race/ethnicity[ Family support[ Doctor-patient relationship[ Religious belief[ Gender[ Social support[ Dependent children[ Acculturation[ | Marital status[ Race/ethnicity[ Family support[ Doctor-patient relationship[ Religious belief[ |
| Physical opportunity | Environmental context and resources | Family economic condition[ Place of living[ Housing type[ | Hospice service center[ Place of living[ |
| Motivation | |||
| Reflective motivation | Intentions | ‒ | ACP attitude[ |
| Goals | ACP belief[ | ‒ | |
| Beliefs about capabilities | ACP motivation[ | ACP motivation[ | |
| Automatic motivation | Emotion | Anxiety and depression[ | Death attitude[ |
表6 晚期癌症患者ACP参与行为影响因素COM-B模型编码结果汇总
Tab 6 Factors influencing ACP engagement behavior of advanced cancer patients coded according to COM-B model
| COM-B | TDF | Facilitator | Barrier |
|---|---|---|---|
| Capability | |||
| Psychological capability | Knowledge | Knowledge of ACP[ Education level[ Accurate knowledge of prognosis[ | Knowledge of ACP[ |
| Behavioural regulation | Knowledge of the time of disease diagnosis[ Prior experience[ | Subjective life expectancy[ | |
| Physical capability | Skills | Age[ Cancer site[ | Disease symptom burden[ |
| Opportunity | |||
| Social opportunity | Social influences | Marital status[ Race/ethnicity[ Family support[ Doctor-patient relationship[ Religious belief[ Gender[ Social support[ Dependent children[ Acculturation[ | Marital status[ Race/ethnicity[ Family support[ Doctor-patient relationship[ Religious belief[ |
| Physical opportunity | Environmental context and resources | Family economic condition[ Place of living[ Housing type[ | Hospice service center[ Place of living[ |
| Motivation | |||
| Reflective motivation | Intentions | ‒ | ACP attitude[ |
| Goals | ACP belief[ | ‒ | |
| Beliefs about capabilities | ACP motivation[ | ACP motivation[ | |
| Automatic motivation | Emotion | Anxiety and depression[ | Death attitude[ |
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