Abstract:

Objective To explore the communication preferences for advance care planning（ACP） among elderly hospitalized patients and to provide references for improving the ACP implementation rate. Methods Convenience sampling was used to select elderly hospitalized patients from a tertiary hospital in Wenzhou City between April and November 2023. Face-to-face surveys were conducted using a general data collection form and a self-designed questionnaire on ACP communication preferences. Mixed Logit Model，willingness-to-pay analysis，relative importance analysis，and subgroup analysis were employed to explore preferences. Results 204 questionnaires were distributed and 200 valid questionnaires were recovered，with a valid questionnaire response rate of 98.04%. The Mixed Logit Model analysis indicated that key attributes—communication timing，communication form，family participation in ACP communication，legal validity of ACP documents，and out-of-pocket costs—significantly influenced preferences（P<0.05）. Willingness-to-pay analysis showed that changes in communication timing，communication form，and family participation altered patients’ willingness to pay. Relative importance analysis ranked the top 3 attributes as communication timing，communication form，and family participation. Subgroup analysis revealed that gender，education level，and residence location affected preferences（P<0.05）. Conclusion Key attributes of ACP communication affect elderly hospitalized patients’ preferences and willingness to pay，with variations across subgroups. Healthcare professionals should develop optimal communication programs based on patient preferences and individual characteristics.

Key words: Elderly, Hospitalized Patients, Advance Care Planning, Preference Research, Discrete Choice Experiment, Palliative Care

摘要：

目的 探究老年住院患者对预立医疗照护计划（advance care planning，ACP）的沟通偏好，为提高ACP开展率提供参考。 方法 采用便利抽样法，于2023年4—11月选取温州市某三级甲等医院的老年住院患者作为调查对象，采用一般资料收集表、自制的ACP沟通偏好问卷进行面对面调查，采用混合Logit模型、支付意愿分析、相对重要性分析及亚组分析探究老年住院患者对ACP的沟通偏好。 结果 发放问卷204份，回收有效问卷200份，有效问卷回收率为98.04%。混合Logit模型分析结果显示，沟通时机、沟通形式、家属是否参与ACP沟通、ACP文书有无法律效力及自付费用等关键属性会影响老年住院患者对ACP的沟通偏好（P<0.05）。支付意愿分析结果显示，沟通时机、沟通形式、家属是否参与ACP沟通3个属性发生转变时，患者的支付意愿会发生改变。相对重要性分析结果显示，重要性排序前3位的依次为沟通时机、沟通形式与家属是否参与ACP沟通。亚组分析结果显示，性别、受教育程度及居住地会影响老年住院患者对ACP的沟通偏好（P<0.05）。 结论 ACP沟通的关键属性会影响老年住院患者对ACP的开展及支付意愿，且不同特征老年住院患者对ACP的沟通偏好不同。医护人员应根据患者的偏好以及个人特征，制订最佳沟通方案。

关键词: 老年人, 住院患者, 预立医疗照护计划, 偏好研究, 离散选择实验, 安宁疗护