Qualitative study on influencing factors of acceptance of advance care planning in patients with end-stage heart failure based on COM-B theory.

OBJECTIVE

Patients with end-stage heart failure (ESHF) face high mortality and complex decision-making needs, yet advance care planning (ACP) acceptance is insufficient in clinical practice. This study aimed to explore factors influencing ACP acceptance among ESHF patients based on the COM-B model, focusing on knowledge deficits, familism, filial piety, and death taboo, to provide evidence for developing culturally adapted ACP interventions in China.

METHODS

A descriptive phenomenological qualitative design was used. Twenty-two ESHF patients were recruited via purposive sampling from a tertiary hospital. Semi-structured in-depth interviews were guided by the COM-B framework. Data were analyzed using Colaizzi's seven-step phenomenological method for coding and theme extraction.

RESULTS

Three core themes and nine sub-themes were identified: (1) Capability: severe lack of disease and ACP knowledge, weak information comprehension and decision-making capacity, and limited information access; (2) Opportunity: family-centered decision-making restricting patient autonomy, filial piety leading to communication avoidance, inadequate medical communication, and cultural taboos causing moral pressure; (3) Motivation: fear triggered by death taboo, weakened autonomous motivation due to filial responsibility, and low perceived benefits of ACP.

CONCLUSION

ACP acceptance among ESHF patients is shaped by cognitive capability, family culture, clinical support, and internal motivation. Insufficient knowledge is the fundamental barrier, and familism and filial piety act as key structural constraints. Culturally adapted interventions based on the COM-B model can effectively improve ACP acceptance and decision-making quality. The findings are transferable to ACP practice in other chronic conditions and collectivist cultural settings.