Key result
Advance care planning acceptance in end-stage HF is restricted by knowledge gaps, family dynamics, and death taboos.
Advance care planning acceptance among Chinese patients with end-stage heart failure is severely limited by knowledge deficits, familism, and filial piety, highlighting the need for culturally adapted interventions.
ACP approaches should not yet change; leaves open culturally tailored intervention studies in Chinese end-stage HF.
Objective: Patients with end-stage heart failure (ESHF) face high mortality and complex decision-making needs, yet advance care planning (ACP) acceptance is insufficient in clinical practice. This study aimed to explore factors influencing ACP acceptance among ESHF patients based on the COM-B model, focusing on knowledge deficits, familism, filial piety, and death taboo, to provide evidence for developing culturally adapted ACP interventions in China. Methods: A descriptive phenomenological qualitative design was used. Twenty-two ESHF patients were recruited via purposive sampling from a tertiary hospital. Semi-structured in-depth interviews were guided by the COM-B framework. Data were analyzed using Colaizzi's seven-step phenomenological method for coding and theme extraction. Results: Three core themes and nine sub-themes were identified: (1) Capability: severe lack of disease and ACP knowledge, weak information comprehension and decision-making capacity, and limited information access; (2) Opportunity: family-centered decision-making restricting patient autonomy, filial piety leading to communication avoidance, inadequate medical communication, and cultural taboos causing moral pressure; (3) Motivation: fear triggered by death taboo, weakened autonomous motivation due to filial responsibility, and low perceived benefits of ACP. Conclusion: ACP acceptance among ESHF patients is shaped by cognitive capability, family culture, clinical support, and internal motivation. Insufficient knowledge is the fundamental barrier, and familism and filial piety act as key structural constraints. Culturally adapted interventions based on the COM-B model can effectively improve ACP acceptance and decision-making quality. The findings are transferable to ACP practice in other chronic conditions and collectivist cultural settings.
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Liu et al. (2026) studied End-stage heart failure (n=22). Factors influencing advance care planning acceptance was evaluated on Themes related to capability, opportunity, and motivation influencing advance care planning acceptance. Advance care planning acceptance among end-stage heart failure patients is restricted by a reinforcing cycle of knowledge deficits, family-centered decision-making, and cultural death taboos.
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