Advance Care Planning (ACP) enables older adults to document future care preferences while cognitively competent. In China, ACP adoption remains limited despite aging population pressures, associated with cultural taboos around death, family-centered decision norms, and socioeconomic disparities. Existing research predominantly employs variable-centered approaches, potentially masking qualitatively distinct subgroups with different engagement patterns. Person-centered analytical methods are needed to identify heterogeneous ACP engagement profiles and inform targeted interventions. This study identified distinct latent profiles of ACP engagement among Chinese older adults using knowledge, attitudes, beliefs, and motivation as LPA indicators within the Knowledge-Attitude-Practice framework and examined sociodemographic and health-related factors associated with profile membership; ACP intention was treated as a distal outcome. A cross-sectional survey was conducted among 1,776 community-dwelling older adults (aged ≥ 60) across multiple Chinese provinces between January and March 2025. Knowledge, attitudes, beliefs, and motivation were entered as LPA indicators; intention was excluded from profile formation and examined as a distal continuous outcome via BCH analysis. R3STEP multinomial logistic regression examined factors associated with profile membership. Three distinct profiles emerged: The Disengaged Group (33%), characterized by uniformly low scores across all four indicators; The Motivated Pioneers Group (26%), displaying above-average beliefs and motivation alongside below-average attitudes; and The Broadly Engaged Group (41%), exhibiting the highest scores across all indicators. Medical insurance type, hospitalization frequency, and bereavement experience were significantly associated with profile membership. BCH-adjusted intention differed significantly across profiles (Broadly Engaged: M = 19.44; Motivated Pioneers: M = 18.83; Disengaged: M = 15.66). Chinese older adults exhibit heterogeneous ACP engagement patterns associated with distinct sociodemographic and experiential factors, supporting profile-tailored interventions: foundational ACP education for The Disengaged Group, decision aids and family communication scripts for the Motivated Pioneers, and system-level facilitation for The Broadly Engaged Group.
Yue et al. (Thu,) studied this question.