Factors influencing home health nurses’ willingness to implement advance care planning based on Terror management theory: a cross-sectional study

With the global aging of populations, advance care planning is essential for ensuring dignified end-of-life care that honors patients’ preferences; however, its implementation in community settings remains limited. Although home health nurses, owing to their close proximity to patients, play a pivotal role, the factors influencing their willingness—particularly psychological responses to death— remain underexplored. Drawing on the Terror management theory, this study investigates how attitudes towards death and the mechanisms affect home health nurses’ willingness to engage in advance care planning, thereby revealing untapped opportunities to bridge the knowledge-practice gap and enhance community-based end-of-life care. This cross-sectional descriptive survey included 153 home health nurses in Korea, recruited online from the Korean Academic Society of Home Health Care Nursing, the Korea Visiting Nurse Association, and the Public Health Nurses Association. Validated Korean instruments were used to measure attitudes toward death, symbolic immortality, self-esteem, and willingness to participate in advance care planning. Data were analyzed using descriptive statistics, Mann–Whitney and Kruskal–Wallis tests, Spearman’s correlations, and stepwise regression using jamovi and the SPSS program. The study participants (98.7% female, mean age: 50.0 ± 9.6 years) reported a high degree of willingness to engage in advance care planning (mean score, 4.33/5). However, only 20.9% had actual advance care planning performance experience, despite 62.7% reporting prior awareness. Neutral acceptance of death correlated positively with willingness (r = .313, p < .001), symbolic immortality (r = .233, p = .004), and self-esteem (r = .181, p = .025). Regression analysis identified ACP awareness (β = 0.30), symbolic immortality (β = 0.21), and neutral acceptance of death (β = 0.18) as predictors, collectively explaining 17.1% of the variance (F = 9.79, p < .001). ACP willingness varied significantly by type of institution (public health centers lower, p = .004) and prior ACP-related experience (p = .036). This novel application of Terror management theory demonstrates how mature attitudes towards death and symbolic immortality function as psychological resources, enabling nurses to overcome death anxiety and fostering advance care planning engagement. By highlighting awareness and psychological buffers as key drivers, these findings inform interventions based on Terror management theory to boost participation, reduce care disparities, and maximize home health nurses’ contributions to patient autonomy and cost-effective end-of-life outcomes in aging societies.