Peng Qiyan, Dong Yujie, Dai Qin, Zhang Chi, Li Xiaoling
Leshan Vocational and Technical College, Leshan, China.
West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Med (Lausanne). 2025 Jun 6;12:1573314. doi: 10.3389/fmed.2025.1573314. eCollection 2025.
This study aims to evaluate the current status of community nurses' willingness to implement Advance Care Planning (ACP) and their attitudes toward death, and to explore the correlation between these variables, providing a basis for improving ACP implementation strategies.
A convenience sampling method was employed to select 317 nurses from 15 community health service centers in Chengdu. Data were collected using a general information questionnaire, the ACP Implementation Willingness Scale, and the Death Attitude Profile-Revised (DAP-R).
The overall score for community nurses' willingness to implement ACP was 56.87 ± 9.73, indicating a moderately high level of willingness. In terms of death attitudes, the highest score was observed in the "natural acceptance" dimension (3.76 ± 0.63), followed by "death avoidance" (3.20 ± 0.81) and "death fear" (3.07 ± 0.80). A significant negative correlation was found between ACP implementation willingness and both "death fear" and "death avoidance" ( = -0.358 to -0.414, < 0.001). In contrast, a positive correlation was observed between ACP implementation willingness and "natural acceptance," "approach acceptance," and "escape acceptance" ( = 0.151 to 0.494, < 0.001). Multiple stepwise linear regression analysis revealed that age, education level, previous exposure to death education training, familiarity with or exposure to ACP, and death attitudes (particularly "death avoidance" and "natural acceptance") were the main factors influencing nurses' willingness to implement ACP, explaining 40.4% of the total variance.
Community nurses' willingness to implement ACP is moderately high; however, their understanding of ACP remains limited. Death attitudes are primarily characterized by "natural acceptance," though negative attitudes toward death, such as "death avoidance," persist. Enhancing death education and training, improving nurses' understanding of ACP, and fostering a more accurate perception of death are essential to facilitate broader ACP implementation in the general population.
本研究旨在评估社区护士实施预先护理计划（ACP）的意愿现状及其对死亡的态度，并探讨这些变量之间的相关性，为改进 ACP 实施策略提供依据。
采用便利抽样法，从成都 15 个社区卫生服务中心选取 317 名护士。使用一般信息问卷、ACP 实施意愿量表和修订版死亡态度量表（DAP-R）收集数据。
社区护士实施 ACP 的意愿总分为 56.87±9.73，表明意愿程度较高。在死亡态度方面，“自然接受”维度得分最高（3.76±0.63），其次是“死亡回避”（3.20±0.81）和“死亡恐惧”（3.07±0.80）。发现 ACP 实施意愿与“死亡恐惧”和“死亡回避”均呈显著负相关（=-0.358 至-0.414，<0.001）。相反，ACP 实施意愿与“自然接受”、“接近接受”和“逃避接受”呈正相关（=0.151 至 0.494，<0.001）。多元逐步线性回归分析显示，年龄、教育水平、既往接受死亡教育培训情况、对 ACP 的熟悉程度或接触情况以及死亡态度（特别是“死亡回避”和“自然接受”）是影响护士实施 ACP 意愿的主要因素，解释了总方差的 40.4%。
社区护士实施 ACP 的意愿程度较高；然而，他们对 ACP 的理解仍然有限。死亡态度主要表现为“自然接受”，不过对死亡的消极态度，如“死亡回避”仍然存在。加强死亡教育培训，提高护士对 ACP 的理解，并培养对死亡更准确的认知，对于在普通人群中更广泛地实施 ACP 至关重要。
