Qualitative assessment of the intention of Chinese community health workers to implement advance care planning using theory of planned behavior

BMC Palliative Care

Bingyu Xing¹  Jinsheng Zhang¹  Qunfang Miao¹  Jing Zhang¹  Zhizhi Jiang²  Guanmian Liang³ 

[1] Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, 311121, Hangzhou, China;Kaixuan Street Community Health Service Center, 310000, Hangzhou, China;Nursing Department, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, Hangzhou, China;

关键词: Community health services;    Medical personnel;    Advance care planning;    Theory of planned behavior;   

DOI  :  10.1186/s12904-021-00885-1

来源: Springer

【 摘 要 】

BackgroundThe aging population coupled with progressive medical technology has increased the demand for improved quality of end-of-life in China. However, implementation of an advance care planning (ACP) program in mainland China is still in its infancy owing to the significant influence of filial piety in Chinese culture. Research on implementation of ACP program among community health workers (CHWs) is limited. The current study sought to explore the willingness of CHWs to implement ACP based on the theory of planned behavior (TPB) and provide a reference for promotion of ACP in Chinese communities.MethodsPhenomenological qualitative study using semi-structured face-to-face interviews. Interviews were audio-recorded. Colaizzi’s method was used for data analysis. The study received ethical approval and all participants provided written consent.ResultsThirteen CHWs from 3 community health service centers (CHSCs) in Hangzhou, Zhejiang Province, China were interviewed. Through the analysis of the interview content, we determined that most CHWs have a supportive attitude towards the implementation of ACP, the reasons for which are as follows: relieve suffering of patients and respect their medical autonomy; relieve economic and psychological burden on family members; promote development of community palliative care. However, some CHWs believe that the implementation of ACP will lead to doctor-patient disputes and medical risks. CHWs reported that the support of patients and their families, community lawyers, psychosocial professionals, and CHSCs senior managers helped them to implement ACP. In addition, they indicated that the improvement of doctor-patient communication ability, the improvement of community medical environment, the support of government policy, and the training of CHWs were the promoting factors influencing their implementation of ACP. The hindrance factors include insufficient allocation of community health human resources, imperfect ACP legislation in China, and deep-rooted traditional culture.ConclusionFindings demonstrated that Chinese CHWs tend to support the implementation of ACP, but their willingness to implement is affected by different factors. CHSCs should actively organize standardized ACP training and comprehensively consider community medical environment, organizational norms, and human resources in implementation of ACP.

【 授权许可】

CC BY