A structured communication model for advance care planning in Chinese oncology nursing: a mixed-methods participatory...

Despite the global recognition of advance care planning as a critical component of patient-centred end-of-life care, its implementation remains challenged by skill-based deficiencies (e.g., inadequate training), cultural and communication barriers, and system-level structural impediments within healthcare settings. This study aimed to develop and implement a structured advance care planning communication model to improve nurses' communication practices and facilitate patient engagement in end-of-life care discussions.

A participatory action research design with embedded mixed methods was conducted from September 2020 to September 2022 in an oncology palliative care unit at an oncology hospital in Beijing, China. The study integrated the Advance Directive Decision-Making Model with the Meaning-Making Intervention. Data collection included surveys, participant observation, and semi-structured interviews across three phases. Four iterative action cycles were used to co-develop and refine the communication model. Quantitative and qualitative data were triangulated through team debriefings to generate meta-inferences.

Initial assessments included surveys and observations. Nurses held a foundational knowledge of advance care planning principles (mean knowledge: 68.52%), but expressed hesitation to initiate end-of-life discussions. Iterative cycles developed a three-step communication model. The steps were: (1) Recognize the Present, (2) Life Review, and (3) Face the Future. Post-action data showed improvements in in all areas. Nurses' knowledge increased significantly (mean score increase: 1.90 points). Attitudes scores increased (mean increase = 0.90) Behaviours scores also increased (mean increase = 0.57). Paired t-tests confirmed significant differences for all measures (p < 0.001). Key improvements attributed to the model included the development of time-efficient communication strategies, structured support systems, and adaptive communication techniques tailored to patient needs.

The structured three-step advance care planning communication model improves nurse-patient communication and patient engagement in end-of-life decision-making. This model provides a practical framework for initiating and guiding advance care planning conversations in oncology care. Future research is needed to evaluate its applicability in diverse settings and its long-term impact on patient outcomes.