Factors associated with facilitating advance care planning based on the theory of planned behaviour

Abstract

Background In Japan, educational support for advance care planning is still limited, and the factors facilitating advance care planning practice have not been identified. The aim of this study is to identify the factors associated with advance care planning practice in Japan using the theory of planned behaviour. Methods We conducted a cross-sectional study through a nationwide online questionnaire survey with 446 Japanese residents aged 20 years and older. After categorizing participants into two groups based on who performed advance care planning, comparisons were made (univariate analysis) regarding attitudes towards advance care planning, willingness to perform advance care planning, subjective norms, sense of control in performing advance care planning, presence of and relationship with a family doctor, experience of seeing or using a ventilator, and degree of self-determination (Autonomy Preference Index) as well as sociodemographic data. In addition, a logistic regression analysis was performed using the factors with significant differences in the univariate analysis as independent variables and the existence of the implementation of advance care planning as a dependent variable. Results The group with advance care planning consisted of 106 participants (23.8%), and the group without advance care planning comprised 340 participants (76.2%). Through logistic regression analysis, age (odds ratio: 1.020), subjective norms (odds ratio: 3.276) and experience with mechanical ventilation (odds ratio: 1.997) were extracted as significant factors influencing advance care planning implementation. Conclusions Advance care planning may be facilitated by providing support not only to the patients but also to their family members to be positively disposed towards advance care planning and by offering comprehensive education regarding using a ventilator.

Older Adults' Behavioral Intentions Toward Advance Care Planning Based on Theory of Reasoned Action

“…The results revealed that the participants' behavioral intentions were affected by age, subjective norms, and experience seeing or using ventilators. 9 However, our results support the theory of reasoned action, which suggests that individuals' knowledge contributes to their attitudes and that attitudes and subjective norms determine behavioral intention. 17 Therefore, it is essential to raise public awareness of ACP.…”

“…A Japanese study used the theory of planned behavior as a framework and conducted a questionnaire survey of 446 people aged 20 years or older. The results revealed that the participants' behavioral intentions were affected by age, subjective norms, and experience seeing or using ventilators 9 . However, our results support the theory of reasoned action, which suggests that individuals' knowledge contributes to their attitudes and that attitudes and subjective norms determine behavioral intention 17 .…”

“…5 Factors affecting an older adult's decision to engage in ACP include age, sex, education level, health status, religious beliefs, knowledge of ACP, personal medical experience, communication with family members, support from family members, medical resources, and cultural sentiments. 3,[6][7][8][9][10][11][12][13][14] A mixed study on older adults with chronic diseases discovered that quality of life, family support, past medical experience, and attitude toward death affected their likelihood of implementing ACP. 15 Another survey study found that the desire among older adults to reduce the burdens of surrogate decision making and older adults' negative experiences with end-of-life care were motivators for ACP.…”

Development and validation of the advance care planning practice preference scale for clinical nurses

“…According to the theory of planned behaviour, individuals will consider the behavioural preference, which is determined by their behavioural attitude, subjective norms and perceived behavioural control before trying to produce a certain behaviour (Young et al, 1991). As shown in Figure 1, these three variables, which have been widely validated in understanding individual behaviour (Takeshita et al, 2021;Yang et al, 2022) Clinical nurses with a low ACP practice preference may be reluctant to lead or participate in ACP discussions with patients and surrogate decision makers, or to expend effort in developing ACP skills and addressing barriers to ACP discussions (Gilissen et al, 2020).…”

Advance Care Planning Among Elderly Acquired Immunodeficiency Syndrome Patients

“…According to TPB, individual behavior is mainly determined by behavioral attitude, subjective norm, and perceived behavioral control. These 3 variables are affected by their corresponding potential cognitive bases and have been widely validated in the field of understanding individual behavior 26 (Figure). Behavioral beliefs are defined as conscious tendencies about the outcome of behavior.…”