Evidence map›Paper›PMID 39301973›Full record

ArticleJournal of clinical nursing2026

Factors Associated with Advance Care Planning Engagement Among Community-Dwelling Older Adults: A Cross-Sectional Study.

Tiet-Hanh Dao-Tran, Ling Yeoh, Tracy Comans, Ava Karusoo-Musumeci, Kirsten A Auret, Ron Sinclair, Michelle M Hilgeman, Josephine M Clayton, Elizabeth Halcomb, Elissa Campbell and 4 more

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In one paragraph

Article in Journal of clinical nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Tiet-Hanh Dao-TranCentre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.ORCID 0000-0003-4175-5648
Ling YeohSchool of Psychology, University of New South Wales, Sydney, Western Australia, Australia.
Tracy ComansCentre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Ava Karusoo-MusumeciNeuroscience Research Australia, Sydney, Western Australia, Australia.
Kirsten A AuretRural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia.
Ron SinclairUniversity of Adelaide, Adelaide, South Australia, Australia.
Michelle M HilgemanTuscaloosa Veterans Affairs Medical Center, Tuscaloosa, Alabama, USA.
Josephine M ClaytonNorthern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Western Australia, Australia.
Elizabeth HalcombSchool of Nursing, University of Wollongong, Wollongong, New South Wales, Australia.ORCID 0000-0001-8099-986X
Elissa CampbellSir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Anne MellerSouth Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
Rebecca WaltonBrightwater Group, Perth, Western Australia, Australia.
Susan KurrleNorthern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Western Australia, Australia.
Craig SinclairSchool of Psychology, University of New South Wales, Sydney, Western Australia, Australia.

Funding

Australian Government National Health and Medical Research Council GNT2006283
6 · The paper itself

Abstract

aimTo explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults.

designA cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.

methodsValidated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.

resultsAnxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.

conclusionIncreased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community-dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community-dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning. IMPACT: Understanding factors associated with advance care planning engagement among community-dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community-dwelling older adults in advance care planning. REPORTING

methodThe STROBE statement checklist was used as a guide to writing the manuscript. PATIENT OR PUBLIC CONTRIBUTION: The study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.

Indexed as

Advance Care PlanningIndependent LivingAgedAged, 80 and overAnxietyAustraliaCross-Sectional StudiesDecision MakingDepressionFemaleHealth LiteracyHumansMaleSurveys and Questionnairesadvance care planninganxietycommunity‐dwelling older adultsdecisional conflictdepression

Identifiers

PMID39301973
PMCPMC13068172

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.