Dao-Tran Tiet-Hanh, Yeoh Ling, Comans Tracy, Karusoo-Musumeci Ava, Auret Kirsten A, Sinclair Ron, Hilgeman Michelle M, Clayton Josephine M, Halcomb Elizabeth, Campbell Elissa, Meller Anne, Walton Rebecca, Kurrle Susan, Sinclair Craig
Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
School of Psychology, University of New South Wales, Sydney, Western Australia, Australia.
J Clin Nurs. 2024 Sep 20. doi: 10.1111/jocn.17458.
To explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults.
A cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.
Validated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.
Anxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.
Increased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community-dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community-dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.
Understanding factors associated with advance care planning engagement among community-dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community-dwelling older adults in advance care planning.
The STROBE statement checklist was used as a guide to writing the manuscript.
The study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.
探讨社区居住的老年人中抑郁、焦虑、决策冲突与预先护理计划参与度之间的关联，以及决策冲突在抑郁、焦虑与预先护理计划之间关联中的潜在中介作用。
2022年8月至10月，对澳大利亚大都市、地区和农村社区的262名社区居住的老年人进行了一项横断面研究。
使用经过验证的自我报告问题收集焦虑、抑郁（医院焦虑抑郁量表）、决策冲突（决策冲突量表）、预先护理计划参与度（预先护理计划参与度调查）和协变量（人口统计学特征、健康素养[健康素养筛查问题]）、总体健康状况（简短健康调查问卷36项）的数据。数据分析包括描述性统计、双变量关联分析、一般线性模型和路径分析。
即使在控制了人口统计学特征、健康素养和总体健康状况的潜在影响后，焦虑和决策冲突仍与预先护理计划参与度直接相关。该模型包括年龄、性别、出生国家、在家说的语言、教育程度、总体健康状况、焦虑、抑郁、决策冲突以及焦虑与决策冲突之间的相互作用，解释了他们预先护理计划参与度差异的24.3%。决策冲突介导了焦虑与预先护理计划参与度之间的关联。
即使在教育程度和健康素养较高的社区居住老年人中，焦虑和决策冲突增加也直接与预先护理计划参与度降低相关。焦虑增加通过决策冲突增加间接与预先护理计划参与度降低相关。医疗保健专业人员应评估社区居住老年人的焦虑，并实施干预措施来管理他们的焦虑和决策冲突，因为这可能有助于他们参与预先护理计划。
了解社区居住老年人中与预先护理计划参与度相关的因素可能为促进他们未来参与预先护理计划的策略提供信息。本研究的结果可作为未来实施的证据，以促进社区居住老年人参与预先护理计划。
使用STROBE声明清单作为撰写手稿的指南。
该研究通过社交媒体（如推特和脸书）和时事通讯（如澳大利亚预先护理计划、志愿服务中心、澳大利亚姑息治疗协会以及一家拥有约7000名接受支持或服务的老年客户的大型家庭护理服务提供商）进行公开宣传以招募参与者。邀请年龄在65岁及以上、独立生活在澳大利亚社区且能用英语交流的人参与并回答问卷。
