Readiness for Advance Care Planning in Patients with Chronic Kidney Disease: A Cross-Sectional Study
Abstract
Background: Chronic Kidney Disease (CKD) patient often face unpredictable progression, leading to sudden deterioration that impair communication of medical preferences in emergencies. Without Advance Care Planning (ACP), treatments may conflict with patient values, causing decisional conflicts and excessive interventions. While ACP helps ensure patient autonomy, there is limited understanding of CKD patients' readiness for ACP restricts healthcare providers from delivering timely and appropriate supportive care.
Purpose: This study aims to identify factors influencing ACP readiness in CKD patients to inform strategies for patient-centered care.
Methods: A cross-sectional study was conducted with non-dialysis CKD patients using the validated Chinese version of the Advance Care Planning Engagement Survey (ACPES). Hierarchical regression analysis assessed the the impact of demographics, social support, and healthcare partnerships on ACP readiness.
Results: The study enrolled 189 participants who demonstrated moderate ACP readiness, with a mean score of 2.17 ± 1.07. Notably, 54-58.2% had considered end-of-life care planning, preferring discussions with decision-makers (32.3-33.3%) over physicians (4.8-6.3%). Regression analysis revealed that female gender (β = 0.17, p < 0.05), older age (β = 0.19, p < 0.05), higher educational levels (high school: β = 0.24, p < 0.01; college: β = 0.22, p < 0.05), and strong healthcare partnerships (β = 0.23, p < 0.01),especially interactions with nurses, were significant predictors of ACP readiness, accounting for 13.8% of the variance.
Conclusion: The study reveals that while CKD patients show moderate ACP readiness, significant gaps exist in engagement, especially in discussions with healthcare providers. Key findings indicate female gender, older age, higher educational levels, and strong healthcare partnerships positively influence ACP readiness. However, many patients hesitate to initiate ACP discussions with physicians, possibly due to perceived hierarchical barriers in healthcare. It is recommended that nursing professionals actively foster ACP readiness by building trusting relationships and empower patients to make decisions aligned with their values. These findings highlight the essential role of healthcare providers, especially nurses, in promoting ACP by enhancing healthcare partnerships to support patient autonomy and improve end-of-life care quality.
Notes
References:
[1] Adenwalla, S. F., O’Halloran, P., Faull, C., Murtagh, F. E. M., & Graham-Brown, M. P. M. (2024). Advance care planning for patients with end-stage kidney disease on dialysis: narrative review of the current evidence, and future considerations. Journal of Nephrology, 37(3), 547-560.
[2] Chen, L. C., Tu, I. T., Yu, I. C., Tung, T. H., Huang, H. P., Lin, Y. C., Beaton, R. D., & Jane, S. W. (2022). The explorations of the awareness, contemplation, self-Efficacy, and readiness of advance care planning, and its predictors in Taiwanese patients while receiving hemodialysis treatment. BMC palliative care, 21(1), 180. https://doi.org/10.1186/s12904-022-01063-7
[3] Kuo, K. M., Chang, I. C., Chen, C. M., & Yang, F. J. (2022). Antecedents and consequences of shared decision making for patients with chronic kidney diseases: A cross-sectional survey. International journal of medical informatics, 168, 104898. https://doi.org/10.1016/j.ijmedinf.2022.104898
[4] Liu, L., Zhao, Y. Y., Zhang, L. H., & Chan, H. Y. (2020). Measuring Self-Efficacy and Readiness for Advance Care Planning in Chinese Older Adults. Journal of pain and symptom management, 60(3), 622–629. https://doi.org/10.1016/j.jpainsymman.2020.06.013
[5] Saeed, F., Ladwig, S. A., Epstein, R. M., Monk, R. D., & Duberstein, P. R. (2020). Dialysis Regret: Prevalence and Correlates. Clinical journal of the American Society of Nephrology : CJASN, 15(7), 957–963. https://doi.org/10.2215/CJN.13781119
[6] Song, M. K., Manatunga, A., Plantinga, L., Metzger, M., Kshirsagar, A. V., Lea, J., Abdel-Rahman, E. M., Jhamb, M., Wu, E., Englert, J., & Ward, S. E. (2024). Effectiveness of an Advance Care Planning Intervention in Adults Receiving Dialysis and Their Families: A Cluster Randomized Clinical Trial. JAMA network open, 7(1), e2351511. https://doi.org/10.1001/jamanetworkopen.2023.51511
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Other
Keywords:
Hospice, Palliative, or End-of-Life, Chronic Kidney Disease, Advance Care Planning, Healthcare Partnership
Recommended Citation
Hsu, Jie-Ru; Chen, Yu-Chi; Lin, Cheng-Pei; Lin, Chih-Ching; and Liu, Chieh-Yu, "Readiness for Advance Care Planning in Patients with Chronic Kidney Disease: A Cross-Sectional Study" (2025). International Nursing Research Congress (INRC). 197.
https://www.sigmarepository.org/inrc/2025/presentations_2025/197
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Readiness for Advance Care Planning in Patients with Chronic Kidney Disease: A Cross-Sectional Study
Seattle, Washington, USA
Background: Chronic Kidney Disease (CKD) patient often face unpredictable progression, leading to sudden deterioration that impair communication of medical preferences in emergencies. Without Advance Care Planning (ACP), treatments may conflict with patient values, causing decisional conflicts and excessive interventions. While ACP helps ensure patient autonomy, there is limited understanding of CKD patients' readiness for ACP restricts healthcare providers from delivering timely and appropriate supportive care.
Purpose: This study aims to identify factors influencing ACP readiness in CKD patients to inform strategies for patient-centered care.
Methods: A cross-sectional study was conducted with non-dialysis CKD patients using the validated Chinese version of the Advance Care Planning Engagement Survey (ACPES). Hierarchical regression analysis assessed the the impact of demographics, social support, and healthcare partnerships on ACP readiness.
Results: The study enrolled 189 participants who demonstrated moderate ACP readiness, with a mean score of 2.17 ± 1.07. Notably, 54-58.2% had considered end-of-life care planning, preferring discussions with decision-makers (32.3-33.3%) over physicians (4.8-6.3%). Regression analysis revealed that female gender (β = 0.17, p < 0.05), older age (β = 0.19, p < 0.05), higher educational levels (high school: β = 0.24, p < 0.01; college: β = 0.22, p < 0.05), and strong healthcare partnerships (β = 0.23, p < 0.01),especially interactions with nurses, were significant predictors of ACP readiness, accounting for 13.8% of the variance.
Conclusion: The study reveals that while CKD patients show moderate ACP readiness, significant gaps exist in engagement, especially in discussions with healthcare providers. Key findings indicate female gender, older age, higher educational levels, and strong healthcare partnerships positively influence ACP readiness. However, many patients hesitate to initiate ACP discussions with physicians, possibly due to perceived hierarchical barriers in healthcare. It is recommended that nursing professionals actively foster ACP readiness by building trusting relationships and empower patients to make decisions aligned with their values. These findings highlight the essential role of healthcare providers, especially nurses, in promoting ACP by enhancing healthcare partnerships to support patient autonomy and improve end-of-life care quality.
Description
This study identifies factors influencing ACP readiness in CKD patient and emphasizes the need for healthcare providers to build trust and strengthen partnerships to facilitate ACP, thereby enhancing patient autonomy and their end-of-life care quality.