Lin Cheng-Pei, Liao Jung-Yu, Huang Chi-Hsien, Cheng Shao-Yi, Tseng Wei-Zhe, Mori Masanori, Chang Hsien-Cheng, Li Chia-Ming, Sun Wen-Jung, Wu Chien-Yi, Chiou Hung-Yi, Yu Sang-Ju, Hsiung Chao A, Chen Ping-Jen
Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
J Palliat Med. 2025 Jan;28(1):50-58. doi: 10.1089/jpm.2024.0106. Epub 2024 Dec 5.
Misconceptions of and cultural differences in aging influence older adults' medical decision-making self-efficacy and engagement in advance care planning (ACP). This study aims to investigate the association between current medical decision-making participation self-efficacy and ACP engagement among older individuals receiving home-based medical care (HBMC) in Taiwan. Baseline data analysis of a nationwide cohort study. Patients aged ≥50 years who had been consistently receiving HBMC for > two months between November 2019 and December 2022 were recruited. Study recruitment took place at six hospitals and 12 community home care institutions. A structured questionnaire was used to collect data on sociodemographic characteristics, decision-making participation self-efficacy, and ACP engagement. Descriptive, stratified, and multivariate logistic regression analyses were performed. In total, 408 HBMC recipients were enrolled (average age: 80.4 years; 55% women). The respondents reported moderate decision-making participation self-efficacy but low ACP engagement. In light of the transtheoretical model of behavior change, participants with moderate or high self-efficacy had a significantly higher chance of reaching the "contemplation stage" for ACP decisions (odds ratio or OR 4.06-27.13). Participants were more likely to reach the "preparation and action stages" for ACP decisions only when they had high self-efficacy (OR 2.76-14.73). Although participants with better current medical decision-making self-efficacy were more likely to contemplate ACP, many did not take action beyond appointing a medical surrogate(s). Strategies to enhance decisional self-efficacy, thereby increasing timely ACP discussions among older adults in home settings in Chinese culture, are warranted. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.
对衰老的误解及文化差异会影响老年人的医疗决策自我效能感以及他们参与预先护理计划（ACP）的程度。本研究旨在调查台湾接受居家医疗护理（HBMC）的老年人当前的医疗决策参与自我效能感与ACP参与度之间的关联。一项全国性队列研究的基线数据分析。招募了在2019年11月至2022年12月期间持续接受HBMC超过两个月的50岁及以上患者。研究招募在六家医院和12家社区居家护理机构进行。使用结构化问卷收集社会人口学特征、决策参与自我效能感和ACP参与度的数据。进行了描述性、分层和多变量逻辑回归分析。总共招募了408名HBMC接受者（平均年龄：80.4岁；55%为女性）。受访者表示决策参与自我效能感中等，但ACP参与度较低。根据行为改变的跨理论模型，自我效能感中等或较高的参与者达成ACP决策“思考阶段”的可能性显著更高（优势比或OR为4.06 - 27.13）。只有当参与者自我效能感高时，他们才更有可能达成ACP决策的“准备和行动阶段”（OR为2.76 - 14.73）。尽管当前医疗决策自我效能感较好的参与者更有可能考虑ACP，但许多人除了指定医疗代理人之外并未采取行动。有必要采取策略提高决策自我效能感，从而在中国文化背景下的居家老年人中增加及时的ACP讨论。试验注册号：ClinicalTrials.gov标识符为NCT04250103，于2020年1月31日注册。
