Community-Dwelling Older Adults' Perspectives and Readiness for Nurse-Led Advance Care Planning in Primary Care: A Qualitative-Driven Mixed-Methods Study.

AIMS: To explore community-dwelling older adults' perspectives on and readiness for advance care planning in primary care settings, integrating qualitative and quantitative findings.

DESIGN

A qualitative-driven convergent mixed-methods study.

METHODS

Four District Health Centres in Hong Kong served as study sites. Survey data were collected from 17 October to 19 November 2025, and focus group interviews were conducted from 31 December 2025 to 22 January 2026. Community-dwelling older adults aged 60 years or above were recruited through purposive sampling for focus group interviews (n = 27) and convenience sampling for a cross-sectional survey (n = 134). Focus group transcripts were analysed using reflexive thematic analysis; survey data were analysed descriptively. Findings were integrated using a convergent joint display.

RESULTS

Six qualitative themes were developed: acceptance of natural death and comfort orientation; family burden and autonomy; healthcare system barriers and trust in medical authority; District Health Centres as a community advance care planning platform; timing and readiness; and place of death preferences. Survey findings indicated limited formal engagement: 32.1% were aware of advance care planning and 6.0% had documented preferences, despite 84.3% recognising 'living will'. The joint display identified 14 integration points (seven confirmations, four expansions, three discordances), with key discordances revealing that informal family end-of-life communication occurs but is not captured by documentation measures and that communal contexts may suppress expressed readiness.

CONCLUSION

Community-dwelling older adults demonstrate forms of engagement with advance care planning that conventional awareness and documentation measures may not capture. District Health Centres offer a promising platform for upstream, nurse-led advance care planning facilitation in primary care.

IMPACT: As the first study to examine advance care planning within District Health Centres in Hong Kong, these findings support integrating advance care planning into routine primary care through a nurse-led, culturally responsive model, with implications for policy and practice.

REPORTING METHOD: This study adhered to the Good Reporting of A Mixed Methods Study (GRAMMS) guideline, with the qualitative strand reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) and the quantitative strand according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

PATIENT OR PUBLIC CONTRIBUTION: Patients and the public were not involved in the design or conduct of this study.