The research field of advance care planning (ACP) for the surrogate decision makers of advanced cancer patients in China is still at the initial stage, and the relevant researches are fragmented and poorly targeted, lacking systematic analysis of the influencing factors.
To systematically review the influencing factors of ACP participation in surrogate decision makers of advanced cancer patients, so as to provide a reference for subsequent researches in this field.
This study was a mixed-methods systematic review. In April 2022, CNKI, Wanfang Data Knowledge Service Platform, PubMed, EmBase, the Cochrane Library, Web of Science, and CBM were searched by computer for the studies related to influencing factors of ACP participation in surrogate decision makers of advanced cancer patients from the inception to 2022-07-01. After evaluating the quality of literature and extracting information from the included studies, the method of JBI Hybrid System Evaluation Guide was used to integrate quantitative studies and qualitative studies after extracting data separately, and then the themes were summarized, obtaining the influencing factors of the final ACP participation in surrogate decision makers.
A total of 11 papers were included after literature screening and evaluation of literature quality, including 5 qualitative studies and 6 cross-sectional studies. The final results were integrated into 4 categories of personal factors, external support, information access, and disease status, involving 22 influencing factors such as religious beliefs and clan culture, social network, ACP understanding, and disease development expectation after integrating the analysis results of quantitative and qualitative studies.
There are multiple influencing factors of ACP participation in surrogate decision makers of advanced cancer patients. Public perception, communication, policies and personal characteristics of surrogate decision makers can affect their ACP participation. Therefore, relevant education should be strengthened to improve public perception, an effective communication mechanism among patients, surrogate decision makers and health care providers should be established, the protection of relevant policies and regulations should be improved to strengthen guidance and intervention on variable factors.
In the initial promotion of pilot hospice care services (HCS) in China, there is an urgent need to evaluate the quality and effectiveness of HCS comprehensively in pilot institutions.
The purpose of this study was to establish a meso-level comprehensive assessment system of hospice care, and to provide a scientific measurement tool for assessing and comparing hospice care in various pilot institutions.
An item pool for establishing a comprehensive assessment system for HCS was constructed through a literature review and small-scale expert interviews from April to May 2021, then the items were rated using a 9-1 grading scheme (the highest grade is 9, while 1 is the lowest) in terms of three aspects (relevance, measurability and feasibility) during two rounds of expert consultation conducted using the RAND/UCLA modified Delphi panel method from June to July 2021.
The Comprehensive Assessment System of Hospice Care (CASHC) was established finally after the items were revised and improved according to the results of two rounds of expert consultation, which consists of 3 primary indicators (structure, process and outcome), 9 secondary indicators (policy guarantee, service provision, patient burden, etc.), 25 tertiary indicators (institutional system guarantee, number of services, per capita cost, etc.) and 81 quaternary indicators (inclusion of institutional development plan, number of hospital discharges and per capita medical cost, etc.). The first round of consultation achieved a response rate of 93.3%, an authority coefficient of 0.900, with values of Kendall's W for the quaternary indicators calculated as 0.194, 0.115, and 0.126, respectively. The second round of consultation achieved a response rate of 92.9% and an authority coefficient of 0.900, with values of Kendall's W for the quaternary indicators of 0.417, 0.241, and 0.322, respectively.
The CASHC consisting of four-level indicators established using the Donabedian's structure-process-outcome framework is an innovative and practical tool, which can be used to quantify and compare the quality and effectiveness of HCS among different pilot institutions or different regions, contributing to the promotion of the standardization and homogenization of HCS in pilot regions.
The cost of end-of-life care is an important topic in health and wellness sector. There are few studies focus on the end-of-life medical expenditures of older adults in China, especially the causes of urban-rural differences in end-of-life medical expenditures in this population.
To investigate the associated factors of medical expenditures of Chinese oldest old population (≥80 years) in the year before their death, and to analyze rural-urban differences in the medical expenditures as well as their causes.
In September 2021, 1 399 oldest-old adults who died in 2014—2018 with full data of medical expenditure and other key variables in the year prior to their death were selected from the participants of Chinese Longitudinal Healthy Longevity Survey 2018. Ordinary least squares regression was used to analyze the associated factors of the medical expenditures. The Oaxaca-Blinder technique was used to decompose urban-rural differences in the expenditures.
The median medical expenses of the participants in the year prior to their death was 3 500.00 yuan, and the interquartile range was 9 000.00 yuan, the logarithmic mean value was (8.09±1.73) yuan. The residence, age at death, gender, marital status, living arrangement, prevalence of disability, prevalence of endowment insurance, place of death, accessibility of medical services, prevalence of being confined to bed, and annual household income per capita were factors associated with the medical expenditures in the year prior to death (P<0.05). After controlling for confounding factors, the medical expenses of the urban participants in the year prior to their death was 42.6% higher than that of participants living in rural areas. According to the findings of Oaxaca-Blinder decomposition, the explainable and unexplainable parts of the urban-rural differences accounted for 32.86% and 67.14%, respectively. Of the explainable part, 18.70% was caused by differences in endowment insurance participation, 30.18% by differences in place of death, and 40.42% by differences in annual household income per capita.
The medical expenditures in the year prior to death in the oldest-old were associated with complex factors, and showed large urban-rural differences. It is essential that efforts should be made to implement healthy aging strategies, balance the allocation of urban and rural medical resources, improve social security system for older adults, and to develop end-of-life care. All of these will help reduce the medical expenditures and improve the quality of life and death of older adults at the end of their life.
