Factors influencing advance care planning engagement behavior in patients with advanced cancer: a systematic review

doi:10.3969/j.issn.1674-8115.2024.04.009

Abstract

Abstract:

Objective ·To systematically integrate relevant influencing factors of advanced cancer patients' engagement behavior in advance care planning (ACP). Methods ·The systematic search of Chinese and English literature on factors influencing ACP engagement behavior in advanced cancer patients from inception to December 2022 in China National Knowledge Infrastructure (CNKI), Wanfang, China Biomedical Literature Database (Sinomed), PubMed, Cochrane Library, Embase, CINAHL, and PsycINFO was conducted. After the literature quality evaluation, content extraction and summary were conducted by two researchers, and the data of quantitative research and qualitative research were extracted and integrated respectively. The final influencing factors of ACP engagement behavior of advanced cancer patients were obtained. With the help of the theoretical domain, they were mapped to the capability, opportunity, motivation-behavior (COM-B) model step by step. Results ·A total of 21 studies were included and 27 factors were summarized, including 9 theoretical domains. Mapping to the COM-B model included 9 capability factors (knowledge of ACP, education level, accurate knowledge of prognosis, knowledge of the time of disease diagnosis, prior experience, subjective life expectancy, age, cancer site, and disease symptom burden), 13 opportunity factors (gender, marital status, race/ethnicity, religious belief, dependent children, family economic condition, place of living, housing type, family support, social support, doctor-patient relationship, acculturation, and whether or not to establish a hospice service center) and 5 motivational factors (ACP attitude, ACP belief, ACP motivation, anxiety and depression, and death attitude). Among them, doctor-patient relationship, religious belief, ACP attitude, educational level, marital status, family support, knowledge of ACP, accurate knowledge of prognosis, age, place of living, attitude toward death, prior experience, and race/ethnicity were more influential factors on ACP engagement behavior. Conclusion ·Based on the COM-B model, the influencing factors of ACP engagement behavior in advanced cancer patients can be comprehensively summarized. Future studies can use the above factors as an entry point to design continuous, multifaceted, and comprehensive interventions based on the COM-B model to promote the practice of ACP engagement behavior in advanced cancer patients.

Key words: advance care planning, cancer, advanced, COM-B model, influencing factor, systematic review

CLC Number:

R473.73

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.

Figures/Tables 7

TrendMD

References 41

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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

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^[19]	2020	Beijing, China	Qualitative study	Phenomenological study	17	Ⅰ: ①②	80%
BAR-SELA G, et al^[23]	2021	Israel	Mixed studies	Phenomenological study Questionnaire investigation	109	Ⅰ: ①②⑧⑨⑩⑪ Ⅱ: ⑥⑦	QN: 73% QL: 80%
WANG Y X, et al^[20]	2019	Hefei, China	Cross-sectional study	Questionnaire investigation	520	Ⅰ: ⑧⑨ Ⅱ: ④⑤⑥⑦⑫ ⑭⑮	64%
WANG L, et al^[18]	2021	Xi'an, China	Cross-sectional study	Questionnaire investigation	72	Ⅱ: ③⑤⑭⑯17 Ⅲ: 18	91%
YAN C X, et al^[16]	2022	Tianjin, China	Cross-sectional study	Questionnaire investigation	206	Ⅰ: ① Ⅲ: ②④⑭	86%
CHEN Y Z, et al^[15]	2022	Guangzhou, China	Cross-sectional study	Questionnaire investigation	120	Ⅲ: ③④⑪19	86%
TANG S T, et al^[30]	2014	Taiwan, China	Cross-sectional study	Questionnaire investigation	2 450	Ⅲ: ⑭2021	86%
WONG S Y, et al^[32]	2012	Hong Kong, China	Cohort study	Questionnaire investigation	191	Ⅲ: 20 Ⅳ: ⑩	77%
HOU X T, et al^[24]	2021	Beijing, China	Cross-sectional study	Questionnaire investigation	264	Ⅲ: ⑤⑥⑫⑬	73%
KIERNER K A, et al^[33]	2010	Austria	Cohort study	Questionnaire investigation	108	Ⅱ: 22	64%
RODENBACH R A, et al^[25]	2021	America	Cross-sectional study	Questionnaire investigation	672	Ⅲ: 19	86%
GARRIDO M M, et al^[31]	2014	America	Cross-sectional study	Questionnaire investigation	606	Ⅲ: 23	82%
NILSSON M E, et al^[34]	2009	America	Cohort study	Questionnaire investigation	668	Ⅲ: 24	86%
TRUE G, et al^[35]	2005	America	Longitudinal study	Questionnaire investigation	68	Ⅲ: ④23	73%
YOO S H, et al^[27]	2020	South Korea	Cohort study	Questionnaire investigation	150	Ⅰ: 25 Ⅳ: 20	86%
BROWN A J, et al^[29]	2016	America	Cross-sectional study	Questionnaire investigation	110	Ⅲ: ③⑥1926	77%
ZHU M L, et al^[21]	2019	Zunyi, China	Cross-sectional study	Questionnaire investigation	90	Ⅱ: ③⑯	59%
WANG Y L^[17]	2021	Shandong, China	Cross-sectional study	Questionnaire investigation	145	Ⅲ: ⑬⑭19	91%
SHEN M J, et al^[28]	2018	America	Cohort study	Questionnaire investigation	279	Ⅲ: 20	77%
SHEN M J, et al^[26]	2020	America	Qualitative study	Phenomenological study	20	Ⅰ: ④⑩⑪1823	55%
JIA Z M, et al^[22]	2022	America	Qualitative study	Phenomenological study	21	Ⅰ: ②⑪27	90%

Author	Year	Area	Design	Research method	Sample size	Influencing factor	Quality rating
QU X L, et al^[19]	2020	Beijing, China	Qualitative study	Phenomenological study	17	Ⅰ: ①②	80%
BAR-SELA G, et al^[23]	2021	Israel	Mixed studies	Phenomenological study Questionnaire investigation	109	Ⅰ: ①②⑧⑨⑩⑪ Ⅱ: ⑥⑦	QN: 73% QL: 80%
WANG Y X, et al^[20]	2019	Hefei, China	Cross-sectional study	Questionnaire investigation	520	Ⅰ: ⑧⑨ Ⅱ: ④⑤⑥⑦⑫ ⑭⑮	64%
WANG L, et al^[18]	2021	Xi'an, China	Cross-sectional study	Questionnaire investigation	72	Ⅱ: ③⑤⑭⑯17 Ⅲ: 18	91%
YAN C X, et al^[16]	2022	Tianjin, China	Cross-sectional study	Questionnaire investigation	206	Ⅰ: ① Ⅲ: ②④⑭	86%
CHEN Y Z, et al^[15]	2022	Guangzhou, China	Cross-sectional study	Questionnaire investigation	120	Ⅲ: ③④⑪19	86%
TANG S T, et al^[30]	2014	Taiwan, China	Cross-sectional study	Questionnaire investigation	2 450	Ⅲ: ⑭2021	86%
WONG S Y, et al^[32]	2012	Hong Kong, China	Cohort study	Questionnaire investigation	191	Ⅲ: 20 Ⅳ: ⑩	77%
HOU X T, et al^[24]	2021	Beijing, China	Cross-sectional study	Questionnaire investigation	264	Ⅲ: ⑤⑥⑫⑬	73%
KIERNER K A, et al^[33]	2010	Austria	Cohort study	Questionnaire investigation	108	Ⅱ: 22	64%
RODENBACH R A, et al^[25]	2021	America	Cross-sectional study	Questionnaire investigation	672	Ⅲ: 19	86%
GARRIDO M M, et al^[31]	2014	America	Cross-sectional study	Questionnaire investigation	606	Ⅲ: 23	82%
NILSSON M E, et al^[34]	2009	America	Cohort study	Questionnaire investigation	668	Ⅲ: 24	86%
TRUE G, et al^[35]	2005	America	Longitudinal study	Questionnaire investigation	68	Ⅲ: ④23	73%
YOO S H, et al^[27]	2020	South Korea	Cohort study	Questionnaire investigation	150	Ⅰ: 25 Ⅳ: 20	86%
BROWN A J, et al^[29]	2016	America	Cross-sectional study	Questionnaire investigation	110	Ⅲ: ③⑥1926	77%
ZHU M L, et al^[21]	2019	Zunyi, China	Cross-sectional study	Questionnaire investigation	90	Ⅱ: ③⑯	59%
WANG Y L^[17]	2021	Shandong, China	Cross-sectional study	Questionnaire investigation	145	Ⅲ: ⑬⑭19	91%
SHEN M J, et al^[28]	2018	America	Cohort study	Questionnaire investigation	279	Ⅲ: 20	77%
SHEN M J, et al^[26]	2020	America	Qualitative study	Phenomenological study	20	Ⅰ: ④⑩⑪1823	55%
JIA Z M, et al^[22]	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