Factors influencing palliative care decision-making participation among elderly patients in the terminal stage: a...

Against the global ageing backdrop, the demand for palliative care among terminally ill elderly patients is rising, but their participation in related decision-making remains generally low. Identifying influencing factors is urgent to improve resource utilization efficiency and care quality.

A convenience sampling method was used to select 426 elderly patients in the terminal stage of life as study subjects. Surveys were conducted using a general information questionnaire, the palliative care Decision-Making Participation Scale, the Palliative Care Attitude Scale, the Three-Dimensional Meaning in Life Scale, and the Perceived Social Support Scale.Quantitative data that were non‑normally distributed are presented as median (interquartile range); categorical data are described using frequencies and percentages. Between‑group comparisons were performed using nonparametric tests. Spearman correlation analysis was applied to examine correlations, and multiple linear regression analysis was conducted to identify influencing factors.

The total score for palliative care decision-making participation among terminally ill elderly patients was 73.00 (64.00, 81.00), while the total score for attitudes towards palliative care was 35.00 (31.75, 39.00). The three-dimensional sense of life meaning score was 49.00 (47.00, 57.00), and perceived social support score was 60.00 (58.00, 64.25). All data are expressed as median (interquartile range). Multivariate linear regression analysis revealed that age, educational attainment, decision-making preference, awareness of advance directives, attitudes towards palliative care, and three-dimensional sense of life meaning were significant factors influencing decision-making participation in palliative care among elderly patients at the end of life (all P < 0.05).

Elderly terminal patients' palliative care decision-making participation remains moderate and urgently needs improvement. The state should strengthen the palliative care system and promote advance directive legislation. Clinically, a tiered collaborative intervention model is needed to convert intentions into actions via multidimensional support, thereby enhancing their decision-making participation, safeguarding end-of-life autonomy and dignity.