Family-related factors associated with acceptance of advance care planning among older adults in China: a nationwide cross-sectional survey

Abstract Background Families play an important role in medical decision-making and end-of-life communication in the Chinese cultural context. However, existing evidence has largely focused on specific populations or individual family characteristics, and the combined contribution of multiple family-related contexts to ACP acceptance among older adults remains unclear. Subject and methods This cross-sectional survey was conducted in mainland China from June to August 2022 using a multi-stage sampling method. A total of 4,120 older adults aged 60 years and above were included. Self-reported acceptance of ACP was assessed using a single-item visual analogue scale (VAS). Stepwise linear regression was used as an exploratory approach to examine family-related factors associated with ACP acceptance. Results The mean score for self-reported ACP acceptance was 62.78 ± 24.59. In the adjusted model, chronic disease, living in Western China, living in a nuclear family, and having siblings were negatively associated with ACP acceptance ( P < 0.05). Experiencing injury events, higher support for death education, better neighbor relationships, higher family social status, better family health, better family communication, and having debts were positively associated with ACP acceptance ( P < 0.05). After family-related factors were added to the model, the explained variance increased by 5.2%, while most family-related standardized coefficients were small, indicating a modest incremental explanatory contribution. Conclusion Several family- and community-related characteristics were associated with self-reported ACP acceptance among older adults in mainland China, but their overall explanatory contribution was modest. Family context may therefore represent one component of a broader set of factors related to ACP acceptance. These exploratory associations do not establish determinants or causal effects and do not demonstrate the feasibility or effectiveness of family-centered ACP interventions.