Han Zhihao, Su Jingjing, Ma Guiyue, Fang Yong, Tang Linxia, Ma Xiaoqin
Department of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China.
Zhejiang Chinese Medical University First Clinical School of Medicine, Hangzhou City, Zhejiang Province, China.
PLoS One. 2025 Jun 16;20(6):e0325551. doi: 10.1371/journal.pone.0325551. eCollection 2025.
The aim of this study was to explore the factors influencing surrogate decision-makers (SDMs) engagement in Advance Care Planning (ACP).
A cross-sectional Study.
A total of 285 SDMs of advanced cancer patients were recruited using convenience sampling methods. All eligible participants completed the structured questionnaires. Univariate and correlation analyses were used to explore the relationship between different variables and the ACP engagement of SDMs. Factors significant previously in univariate or correlation analyses were included in the multiple linear regression analyses with P < 0.05.
Eight factors in univariate analyses and three factors in correlation analyses with P < 0.05 were taken into multiple linear regression analyses. Finally, seven variables revealed a statistically significant association with ACP engagement of SDMs and were included in the multiple linear regression model.
This cross-sectional study demonstrated that multiple factors, including experiences of medical decision-making, education level, knowledge of ACP, treatment expenditure, uncertainty of disease, social support, and life orientation, significantly impacted the engagement of SDMs in ACP.
Based on this study, we have identified some factors influencing the ACP engagement of SDMs, which might provide basic information for construction of the educational scheme of ACP in mainland China and help to improve SDMs' engagement in clinical ACP practice in the future.
SDMs of advanced cancer patients participated in this study, and assisted in assessing the validation of the measurements.
本研究旨在探讨影响替代决策者（SDM）参与预立医疗照护计划（ACP）的因素。
横断面研究。
采用便利抽样方法招募了285名晚期癌症患者的替代决策者。所有符合条件的参与者均完成了结构化问卷。采用单因素分析和相关性分析来探讨不同变量与替代决策者参与预立医疗照护计划之间的关系。在单因素分析或相关性分析中具有显著意义（P<0.05）的因素被纳入多元线性回归分析。
单因素分析中的8个因素和相关性分析中P<0.05的3个因素被纳入多元线性回归分析。最后，7个变量显示与替代决策者参与预立医疗照护计划存在统计学显著关联，并被纳入多元线性回归模型。
这项横断面研究表明，包括医疗决策经验、教育水平、预立医疗照护计划知识、治疗费用、疾病不确定性、社会支持和生活取向等多种因素，对替代决策者参与预立医疗照护计划有显著影响。
基于本研究，我们确定了一些影响替代决策者参与预立医疗照护计划的因素，这可能为中国大陆预立医疗照护计划教育方案的构建提供基础信息，并有助于提高替代决策者在未来临床预立医疗照护计划实践中的参与度。
晚期癌症患者的替代决策者参与了本研究，并协助评估测量的有效性。
