Association Between Caregiving Stress and Advance Care Planning Behavioral Intentions Among Family Caregivers: A Cross-Sectional Survey

Family caregivers are pivotal in older adults' care and decision-making processes. Notably, few studies have examined the relationship between caregiving stress and family caregivers' advance care planning (ACP) behavioral intentions or the factors associated with ACP behavioral intentions. This study explored the relationship between caregiving stress and ACP behavioral intentions among family caregivers and the factors associated with ACP behavioral intentions. A cross-sectional survey was conducted among family caregivers of hospitalized patients aged >65 years from a medical center in northern Taiwan. The main measurements were a questionnaire on knowledge, attitudes, and behavioral intentions regarding the implementation of ACP and the Kingston Caregiver Stress Scale. In total, 507 valid responses were received. The mean age of the caregivers was 55.3 years, and caregiving stress levels were low to moderate. The caregivers demonstrated fair knowledge of ACP and generally positive attitudes and behavioral intentions toward its implementation. Caregiver stress was not significantly correlated with ACP knowledge, attitudes, or behavioral intentions. In addition, caregiver attitudes and subjective norms, caregiver cancer status, experience with advance directives, and care recipient renal disease status were associated with caregiver behavioral intentions toward ACP. Caregiver stress was not associated with ACP behavioral intentions from the findings. The current results highlight the need to consider the personal illness experiences of family caregivers, plans for future medical management, and the process of caring for older care recipients in promoting ACP among family caregivers.