Profiling Large-Scale Advance Care Planning Engagement Patterns Among Chinese Older Adults: A Multi-Regional Cluster Ensemble Approach for Precision Interventions

This mixed-methods study examined advance care planning engagement patterns among 3,342 Chinese older adults through cluster ensemble analysis, identifying three distinct archetypes: measured-belief moderate motivators (n=1,068), weak-conviction disinterested types (n=1,120), and high-conviction strongly-motivated believers (n=1,461). Validated questionnaires assessed knowledge, attitudes, beliefs, and motivations toward advance care planning. Phenomenological interviews with 30 purposively selected participants explored cluster-specific barriers and facilitators. Data encompasses quantitative survey responses (demographic characteristics, psychometric assessments), clustering algorithm outputs (K-means, agglomerative, spectral, Gaussian mixture model, voting, consensus matrix), and qualitative interview transcripts with thematic coding. Findings revealed culturally distinct engagement profiles shaped by filial piety, mortality perspectives, and family decision-making dynamics, informing precision intervention strategies tailored to each archetype's motivational readiness and structural support needs within Chinese healthcare contexts.