The Role of Advance Care Planning on Community Dwelling Adults' Coping Abilities and Death Attitudes: A Sequential Mixed-Methods Study.

Aim: To (1) examine the attitudes of community-dwelling adults towards death and their ability to cope with death, as well as (2) understand the influence of advance care planning on community-dwelling adults' death attitudes and coping with death.

Design: A sequential explanatory mixed-methods study was conducted in Singapore.

Methods: In Phase I, a case-control study was conducted to examine the differences in death attitudes and coping with death ability between community-dwelling adults who have completed advance care planning and those who have not. A univariate general linear model was used to compute the mean difference in death attitudes and coping with death scores. In Phase II, a descriptive qualitative study was conducted to provide an in-depth understanding of the influence of advance care planning among community-dwelling adults. Thematic analysis was used for qualitative analysis. Mixed-methods analysis was conducted to integrate the quantitative and qualitative data.

Results: In Phase I, 80 community-dwelling adults who had completed advance care planning and 81 community-dwelling adults who did not have advance care planning were included. Adults who had completed advance care planning had significantly higher coping with death scores (t = 4.14, p < 0.01). In Phase II, a purposive sample of 24 adults who had completed advance care planning was selected for individual semi-structured interviews. From the thematic analysis, three themes were developed: (1) Advance care planning enables coping with death, (2) overcoming fear of death with advance care planning and (3) confronting death with advance care planning.

Conclusion: Advance care planning may influence death attitudes and coping with death. Further work on longitudinal designs and among individuals from different age groups should be used to gain further in-depth understanding of the impacts of advance care planning.

Implications For The Profession And/or Patient Care: Strategies to enhance one's coping abilities with death and death attitudes should be developed to stimulate the uptake of advance care planning.

Reporting Method: This paper was reported according to the Good Reporting of A Mixed Methods Study framework.

Patient Or Public Contribution: Community-dwelling adults participated in the survey and interviews.