Consistency in Advance Care Planning Awareness, Attitudes, and Engagement Among Older Adults With Chronic Diseases and Their Families in China: A Mixed Methods Study

PURPOSE: To investigate consistency in awareness, attitudes, and engagement in advance care planning (ACP) among older adults with chronic illnesses and their families, as well as influencing factors. METHOD: A mixed methods sequential explanatory design was used, with data collected from 312 patient-family member dyads via validated questionnaires and 11 dyads through semi-structured interviews. RESULTS: Key findings revealed low consistency in ACP awareness (Kappa = 0.191 to 0.449), with 97.76% of participants unfamiliar with ACP terminology. General positive attitudes toward ACP were observed, with 70.51% viewing it as meaningful (Kappa = 0.431), although engagement consistency was low (intraclass correlation coefficient = 0.109 to 0.390). Qualitative findings identified personal and familial characteristics, family dynamics, traditional culture, and clinical decision-making models as influential factors. CONCLUSION: Despite generally positive attitudes toward ACP, low consistency in awareness and engagement among Chinese older adults and their families necessitate the implementation of culturally sensitive, family-centered ACP interventions.