Purpose
This scoping review aimed to identify the current state of the application of theories in research related to advance care planning and to analyze the types and characteristics of the theories applied. Methods: Using the scoping review methodology presented by Arksey & O'Malley, the articles published from 2010 to 2022 were searched by combining the terms "advance care planning," "theory," and "model" in five electronic databases; PubMed, CINAHL, EMBASE, KMBASE, and KISS. Results: Thirty-two studies were identified. Theory-based research has been actively conducted since 2019, with a total of 25 theories applied. Psychological theories were the most prevalent, accounting for 75.0% of the applications, followed by sociological theories (12.5%), public health theories (6.3%), and one nursing theory (3.1%). Theories were utilized to create a framework for data analysis, establish a philosophical underpinning, develop intervention frameworks, and derive new tools. Conclusion: Various theories have been applied to research on advance care planning, yet the application of nursing theory has been limited. To optimize end-of-life care and advance care planning from a nursing perspective, further research incorporating nursing theory is essential.

PURPOSE
As advanced medical care has resulted in the unintended consequence of prolonging deaths, there is a growing interest in the decision to withhold life-sustaining treatments. The purpose of this study was to determine factors associated with the decision to withhold life-sustaining treatments in middle-aged and older adults who die in hospital in the United States.
METHODS
This cross-sectional correlational study conducted secondary analysis of 2000–2012 exit interview data from the Health and Retirement Study. Adults aged 50 and older who died in hospital and who had made a decision regarding life-sustaining treatments were included. Multivariable logistic regression was used to identify factors related to the decision to withhold life-sustaining treatments.
RESULTS
Among 1,412 adults, the prevalence of the decision to withhold life-sustaining treatments was 61.1%. Significant factors associated with the decision to withhold life-sustaining treatments were being African American (Adjusted Odds Ratio [AOR]=0.50, 95% Confidential Interval [CI]=0.30~0.86), Catholic (AOR=0.5, 95% CI=0.32~0.93), having at least one private insurance policy (AOR=1.40, 95% CI=1.02~1.92), having a living will (AOR=1.71, 95% CI=1.04~2.83), and having discussed end-of-life care with someone (AOR=1.810, 95% CI=1.25~2.62).
CONCLUSION
Differences in race and religious affiliation should be considered when older adults, family members, and health care providers make decisions regarding life-sustaining treatments at the end-of-life. Also, health insurance coverage for advance care planning makes it easier for people to discuss life-sustaining treatments with health care providers.

PURPOSE
The aims of this study were to identify the reported attitudes of older patients with cancer toward advance directives (ADs) and the factors associated with their attitudes toward ADs.
METHODS
The design was a cross-sectional survey. The age mean of the 130 participants were 70.8, and 66.2% of the participants were male. The data were collected at one university hospital in Seoul, South Korea during the period from October 1st to December 5th in 2013. The data collecting instruments were the Advance Directives Attitude Survey (ADAS) and questionnaires including socio-demographic and disease-related characteristics, family function.
RESULTS
30.0% of the participants were aware of ADs, only 9% of them had been informed by healthcare providers. Most participants (93.1%) intended to complete ADs. The mean score of ADAS was 48.29. The stepwise linear regression analysis indicated that family function, perceived health status, period of education, and age accounted for a significant percentage (52.0%, p<.001) of the variance in participants' ADAS. The variable with the greatest effect was family function.
CONCLUSION
The findings suggest that family function and attitude of older cancer patients need to be considered for adapting ADs to Korean health care systems. Healthcare providers should include family members in advanced care planning discussions.

Citations

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