Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Pharmacy, Monash University, Selangor, Malaysia.
International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
J Am Med Dir Assoc. 2023 Dec;24(12):1831-1842. doi: 10.1016/j.jamda.2023.09.008. Epub 2023 Oct 14.
To systematically synthesize the views of community-dwelling Asians on Advance care planning and to summarize the factors and reasons affecting their uptake of ACP.
Mixed-methods systematic review (PROSPERO: CRD42018091033).
Asian adults (≥18 years old) living in the community globally.
Medline (Ovid), Web of Science, CINAHL (EBSCO), Open Grey, and Google Scholar were searched from inception to June 30, 2022. Qualitative, quantitative, or mixed-methods studies reporting on the views of non-seriously ill community-dwelling Asian adults on ACP or the factors influencing their ACP uptake were included. Secondary research, studies not published in English, or studies not available as full text were excluded. Two independent teams of researchers extracted data, assessed methodologic quality, and performed the data analysis. Data analysis was conducted using the multistep convergent integrated approach based on Joanna Briggs Institute methodology for mixed-methods systematic review.
Fifty-eight studies were included. Non-seriously ill community-dwelling Asians were willing to engage in ACP (46.5%-84.4%) although their awareness (3.1%-42.9%) and uptake of ACP remained low (14.0%-53.4%). Background factors (sociodemographic factors, and health status, as well as experience and exposure to information) and underlying beliefs (attitude toward ACP, subjective norm, and perceived behavioral control) were found to affect their uptake of ACP. A conceptual framework was developed to facilitate a proper approach to ACP for this population.
A flexible approach toward ACP is needed for non-seriously ill community-dwelling Asians. There is also a need to raise end-of-life and ACP literacy, and to explore ways to narrow the gap in the expectations and implementation of ACP so that trust in its effective execution can be built.
系统综合社区居住的亚洲人对预先医疗指示的看法，并总结影响他们接受预先医疗指示的因素和原因。
混合方法系统综述（PROSPERO：CRD42018091033）。
全球居住在社区中的亚洲成年人（≥18 岁）。
从成立到 2022 年 6 月 30 日，在 Medline（Ovid）、Web of Science、CINAHL（EBSCO）、Open Grey 和 Google Scholar 上进行了搜索。纳入了报告非重病社区居住的亚洲成年人对预先医疗指示的看法或影响其接受预先医疗指示的因素的定性、定量或混合方法研究。排除了二次研究、未以英文发表的研究或无法获得全文的研究。两组独立的研究人员提取数据、评估方法学质量并进行数据分析。数据分析采用基于 Joanna Briggs 研究所混合方法系统综述方法的多步骤收敛综合方法进行。
纳入了 58 项研究。非重病社区居住的亚洲人愿意参与预先医疗指示（46.5%-84.4%），尽管他们的意识（3.1%-42.9%）和预先医疗指示的接受率仍然较低（14.0%-53.4%）。背景因素（社会人口因素、健康状况以及对信息的经验和暴露）和潜在信念（对预先医疗指示的态度、主观规范和感知行为控制）被发现影响他们接受预先医疗指示。制定了一个概念框架，以促进对这一人群的适当的预先医疗指示方法。
对于非重病社区居住的亚洲人，需要采取灵活的预先医疗指示方法。还需要提高生命末期和预先医疗指示的知识水平，并探索缩小期望和实施预先医疗指示差距的方法，以便建立对其有效执行的信任。
