Qualitative Study on Pre-established Medical Care Plan for Advanced Cancer Patients based on Dualistic Coping Theory

Abstract

Objective: To analyze advanced cancer patients and the factors that promote/hinder their participation in advance medical care plan (ACP), and to provide reference for the construction of ACP. Methods: Under the guidance of dualistic coping theory, qualitative research methods were used to select advanced cancer patients who were hospitalized in a first-class tumor hospital in Shaanxi Province from May 1 to June 30, 2026. Semi-structured interviews were conducted, and the interview data were analyzed by directional content analysis. Results: The advanced cancer patients and the factors promoting/hindering their participation in ACP were divided into 3 themes and 10 sub-themes. (1) Disease and death stress ACP awareness, including disease experience to promote the formation of ACP awareness, family responsibility to drive decision-making needs. (2) Realistic pressure and insufficient cognition hinder the advancement of ACP, including cultural taboos avoiding ACP issues, cognitive biases restricting ACP decision-making participation, and economic pressure weakening ACP discussion willingness. (3) Dual collaboration jointly shapes couples’ ACP coping behaviors, including protective avoidance hinders ACP communication, protective buffer leads to two-way emotional depression, non-verbal companionship supports dual emotional coping, husband and wife roles complement each other to maintain family coping, and two-way empowerment improves disease coping resilience. Conclusion: At present, patients with advanced cancer and their participation in ACP have significant dual impact characteristics. Clinical ACP should be based on the core characteristics of localized family collective decision-making in my country, focusing on patients-dual core groups to implement collaborative intervention, abandoning solidified and single intervention, and establish a dynamic and phased ACP intervention system that adapts to the changes in patients’ conditions, the psychological state of couples, and local family decision-making.