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。
关键词：预立医疗照护计划
;
癌症
;
晚期
;
COM-B模型
;
影响因素
;
系统综述
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.
Keywords：advance care planning
;
cancer
;
advanced
;
COM-B model
;
influencing factor
;
systematic review
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. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2024, 44(4): 482-493 doi:10.3969/j.issn.1674-8115.2024.04.009
目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］。近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］。癌症患者参与终末期医疗照护亟需重视。预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］。而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］。患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值。
计算机全面检索中国知网、万方、中国生物医学文献数据库（Sinomed）、PubMed、Cochrane Library、Embase、CINAHL、PsycINFO等数据库中关于晚期癌症患者ACP参与行为影响因素的中英文文献。采用主题词和关键词、自由词相结合的检索方式，不同数据库的检索策略稍有不同，并同时追溯纳入文献的参考文献和相关系统评价纳入的文献以查全。检索期限为从各数据库建库至2022年12月。中文检索词包括：“预立医疗照护计划/预立医疗指示/预设医疗指示/预先医疗指示/生前预嘱”“晚期/终末期”“肿瘤/癌症/癌/瘤”；英文检索词包括：“advance care planning/advance directs/living wills/medical power of attorney”“terminal/advance/end-stage/end-of-life”“neoplasms/cancer/tumor/oncology/malignancy”。以PubMed为例，检索策略如表1所示。
Tab 1
表1
表1PubMed 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]
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
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[23]
→Patients do not know, do not understand or misunderstand the related concepts of ACP[19]
Education level
→Cultural education can help patients engage in discussion APC[26]
Behavioural regulation
Prior experience
→Patients with disease experience are more likely to discuss ACP[23]
Physical capability
Skills
Cancer site
→Lung cancer patients are more likely to complete advanced directives/Durable Power of Attorney (DPOA) than brain cancer patients[23]
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[26]
Religious belief
→Overly optimistic religious beliefs will affect patients' discussion about ACP[26]
Family support
→Patients hope to have open communication with family members[23]
→Involving family in conversations about end-of-life care can help Latinos to communicate[26]
→No close relatives agree to take responsibility for preventing patients from engaging in ACP[23]
→No close relatives can be trusted for preventing patients from engaging in ACP[23]
Doctor-patient relationship
→Patients prefer for the trusted doctors to initiate ACP conversations[22-23, 26]
→Patients hope to have open communication with physician[23]
→Patients' preconceived notions of clinicians' professional responsibility may hinder public discussion of future health care goals and values[22]
Social support
→Providing culturally counseling services and educational materials can help patients learn how to communicate information about ACP[26]
Acculturation
→A key regulator of how patients view ACP is their cultural adaptation to local norms of care, behavior, and communication[22]
Physical opportunity
Environmental context and resources
Place of living
→Living in rural areas has a positive impact on patients' willingness to participate in ACP[22]
Motivation
Reflective motivation
Intentions
ACP attitude
→Uncertainty about the timing of patients' engagement in ACP[19, 23]
→Patients believe that engagement in ACP increases negative emotions[19]
→Patients question whether ACP itself can be carried out smoothly[19]
→Patients' belief in an uncertain future may hinder public discussion of future health care goals and values[22]
Goals
ACP belief
→Patients hope to make the best medical decisions and avoid unnecessary medical measures[23]
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[23]
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
FU Yiling and WU Qian were responsible for manuscript writing. FU Yiling and WU Aihong were responsible for data extraction and organization. XIA Xuelan was responsible for revision. LUO Xiaoqing and ZHENG Min was responsible for the study conception and paper review. All authors have read the final manuscript and agreed to its submission.
利益冲突声明
所有作者声明不存在利益冲突。
COMPETING INTERESTS
All authors disclose no relevant conflict of interests.
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... 目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］.近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］.癌症患者参与终末期医疗照护亟需重视.预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］.而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］.患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值. ...
1
... 目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］.近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］.癌症患者参与终末期医疗照护亟需重视.预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］.而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］.患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值. ...
1
... 目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］.近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］.癌症患者参与终末期医疗照护亟需重视.预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］.而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］.患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值. ...
1
... 目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］.近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］.癌症患者参与终末期医疗照护亟需重视.预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］.而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］.患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值. ...
1
... 目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］.近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］.癌症患者参与终末期医疗照护亟需重视.预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］.而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］.患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值. ...
2
... 目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］.近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］.癌症患者参与终末期医疗照护亟需重视.预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］.而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］.患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值. ...
... 目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］.近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］.癌症患者参与终末期医疗照护亟需重视.预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］.而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］.患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值. ...
... 目前，我国癌症的发病及死亡率已居全球首位，且多数患者在确诊时已是晚期［1］.近年来，随着人们自主意识的提高，患者对安宁疗护和“优逝”的照护需求日益增加［2］.癌症患者参与终末期医疗照护亟需重视.预立医疗照护计划（advance care planning，ACP）指患者及家属与医护人员沟通未来医疗决策的健康行为过程，旨在满足患者的临终照护意愿，改善其健康结局［3］.而我国ACP研究多集中于态度层面，缺乏反映行为层面影响因素的研究，限制了ACP的进一步实施与推广［4］.患者ACP参与行为受多方面因素的影响［5］，基于健康相关行为理论来确定患者ACP参与行为的影响因素有助于对患者采取针对性干预措施［6］，具有重要的临床价值. ...
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
→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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
→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[20]
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[33]
... →Patients prefer for the trusted doctors to initiate ACP conversations[22-23, 26] ...
... →Patients' preconceived notions of clinicians' professional responsibility may hinder public discussion of future health care goals and values[22] ...
... [22]
Physical opportunity
Environmental context and resources
Place of living
→Living in rural areas has a positive impact on patients' willingness to participate in ACP[22]
Motivation
Reflective motivation
Intentions
ACP attitude
→Uncertainty about the timing of patients' engagement in ACP[19, 23] ...
... [22]
Motivation
Reflective motivation
Intentions
ACP attitude
→Uncertainty about the timing of patients' engagement in ACP[19, 23] ...
... →Patients' belief in an uncertain future may hinder public discussion of future health care goals and values[22] ...
... →Getting more information about ACP can help patients to understand its significance[23] ...
... →Patients do not know, do not understand or misunderstand the related concepts of ACP[19]
Education level
→Cultural education can help patients engage in discussion APC[26]
Behavioural regulation
Prior experience
→Patients with disease experience are more likely to discuss ACP[23]
Physical capability
Skills
Cancer site
→Lung cancer patients are more likely to complete advanced directives/Durable Power of Attorney (DPOA) than brain cancer patients[23]
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[26]
Religious belief
→Overly optimistic religious beliefs will affect patients' discussion about ACP[26]
Family support
→Patients hope to have open communication with family members[23] ...
... [23]
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[26]
Religious belief
→Overly optimistic religious beliefs will affect patients' discussion about ACP[26]
Family support
→Patients hope to have open communication with family members[23] ...
... →Patients hope to have open communication with family members[23] ...
... →No close relatives agree to take responsibility for preventing patients from engaging in ACP[23] ...
... →No close relatives can be trusted for preventing patients from engaging in ACP[23] ...
... →Patients prefer for the trusted doctors to initiate ACP conversations[22-23, 26] ...
... →Patients hope to have open communication with physician[23] ...
... →Uncertainty about the timing of patients' engagement in ACP[19, 23] ...
... →Patients' belief in an uncertain future may hinder public discussion of future health care goals and values[22]
Goals
ACP belief
→Patients hope to make the best medical decisions and avoid unnecessary medical measures[23]
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[23]
... →Patients do not know, do not understand or misunderstand the related concepts of ACP[19]
Education level
→Cultural education can help patients engage in discussion APC[26]
Behavioural regulation
Prior experience
→Patients with disease experience are more likely to discuss ACP[23]
Physical capability
Skills
Cancer site
→Lung cancer patients are more likely to complete advanced directives/Durable Power of Attorney (DPOA) than brain cancer patients[23]
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[26]
Religious belief
→Overly optimistic religious beliefs will affect patients' discussion about ACP[26]
Family support
→Patients hope to have open communication with family members[23] ...
... [26]
Religious belief
→Overly optimistic religious beliefs will affect patients' discussion about ACP[26]
Family support
→Patients hope to have open communication with family members[23] ...
... [26]
Family support
→Patients hope to have open communication with family members[23] ...
... →Involving family in conversations about end-of-life care can help Latinos to communicate[26] ...
... →Patients prefer for the trusted doctors to initiate ACP conversations[22-23, 26] ...
... →Patients' preconceived notions of clinicians' professional responsibility may hinder public discussion of future health care goals and values[22]
Social support
→Providing culturally counseling services and educational materials can help patients learn how to communicate information about ACP[26]
Acculturation
→A key regulator of how patients view ACP is their cultural adaptation to local norms of care, behavior, and communication[22]
Physical opportunity
Environmental context and resources
Place of living
→Living in rural areas has a positive impact on patients' willingness to participate in ACP[22]
Motivation
Reflective motivation
Intentions
ACP attitude
→Uncertainty about the timing of patients' engagement in ACP[19, 23] ...
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
... Descriptive analysis results of quantitative studyTab 5
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[16]
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[18]
Subjective life expectancy
→Patients who are expected to live only a few months are less likely to prefer aggressive treatment[27]
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[29]
Opportunity
Social opportunity
Social influences
Family support
→Family members not objecting is an important factor in discussing ACP[32]
Social support
→Patients with higher social support are more willing to engage in ACP[18]
Doctor-patient relationship
→Poor doctor-patient relationship leads to low acceptance of ACP[15]
Dependent children
→Patients with dependent children are more likely to prefer aggressive treatment and less likely to engage in ACP[34]
Physical opportunity
Environmental context and resources
Housing type
→Patients without private housing are more willing to engage in ACP[20]
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[30]
Motivation
Reflective motivation
Intentions
ACP attitude
→The sense of life meaning is the main factor influencing patients' attitude towards ACP[16]
Goals
ACP belief
→Patients want to ensure a comfortable end-of-life and avoid pain[20]
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[20]
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[33]
