{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T06:02:59Z","timestamp":1794376979334,"version":"4.9.0"},"reference-count":55,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"unspecified","delay-in-days":140,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951526102636_sec1a\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The relationship between frailty, self-efficacy, and advance care planning (ACP) remains unclear in Asia. This study examined how frailty status relates to decisional self-efficacy, ACP engagement, and advance directive completion among older adults receiving home healthcare in Taiwan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102636_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional analysis was conducted using baseline data from a nationwide cohort in Taiwan. Participants (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0358) were categorized by Clinical Frailty Scale (CFS): mildly frail (CFS 4\u20135,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a060), moderately frail (CFS 6,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a083), severely frail (CFS 7,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0147), and very severely frail (CFS 8\u20139,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a068). ACP engagement and decision-making self-efficacy were assessed using Likert scales.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102636_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with greater frailty had lower odds of high decisional self-efficacy (CFS: 8\u20139: odds ratio [OR]\u00a0=\u00a00.38, 95% confidence interval [CI]\u00a0=\u00a00.14\u20131.07) but higher odds of ACP engagement (CFS: 6: OR\u00a0=\u00a03.38, 95% CI\u00a0=\u00a01.40\u20138.17; CFS: 7: OR\u00a0=\u00a02.52, 95% CI\u00a0=\u00a01.08\u20135.89) compared with mildly frail individuals. However, this increase did not extend linearly to the very severely frail group. Advance directive completion remained low across all frailty levels (4.8\u201310.0%) and was not significantly associated with frailty status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102636_sec4d\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Frailty was associated with lower decisional self-efficacy but higher readiness for ACP, revealing a divergence between perceived confidence and planning motivation. Despite greater engagement, advance directive completion remained low. Stage-sensitive, values-based approaches may help bridge the gap between intention and documentation across the frailty spectrum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951526102636","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:12:33Z","timestamp":1779358353000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Frailty and the confidence to plan ahead: Decision-making self-efficacy and advance care planning among older adults receiving home healthcare"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4619-5144","authenticated-orcid":false,"given":"Chi Hsien","family":"Huang","sequence":"first","affiliation":[{"name":"E-Da Hospital, I-Shou University"},{"name":"I-Shou University"},{"id":[{"id":"https:\/\/ror.org\/03gk81f96","id-type":"ROR","asserted-by":"publisher"}],"name":"Kaohsiung Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5810-8776","authenticated-orcid":false,"given":"Cheng-Pei","family":"Lin","sequence":"additional","affiliation":[{"name":"National Yang Ming Chiao Tung University"},{"name":"Midwifery and Palliative Care, King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly Yen-Chih","family":"Chen","sequence":"additional","affiliation":[{"name":"E-Da Hospital, I-Shou University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Yu","family":"Liao","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/059dkdx38","id-type":"ROR","asserted-by":"publisher"}],"name":"National Taiwan Normal University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Yi","family":"Cheng","sequence":"additional","affiliation":[{"name":"College of Medicine and Hospital, National Taiwan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Zhe","family":"Tseng","sequence":"additional","affiliation":[{"name":"Kaohsiung Medical University Hospital, Kaohsiung Medical University"},{"name":"College of Medicine, National Cheng Kung University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Umegaki","sequence":"additional","affiliation":[{"name":"Nagoya University Graduate School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsien-Cheng","family":"Chang","sequence":"additional","affiliation":[{"name":"Keelung City Health Bureau"},{"name":"Lotung Poh-Ai Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Ming","family":"Li","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}],"name":"National Taiwan University Hospital Beihu Branch"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Jung","family":"Sun","sequence":"additional","affiliation":[{"name":"Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation)"},{"id":[{"id":"https:\/\/ror.org\/02gzfb532","id-type":"ROR","asserted-by":"publisher"}],"name":"Taipei City Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Yi","family":"Chiou","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02r6fpx29","id-type":"ROR","asserted-by":"publisher"}],"name":"National Health Research Institutes"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Ju","family":"Yu","sequence":"additional","affiliation":[{"name":"Home Clinic Dulan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao A.","family":"Hsiung","sequence":"additional","affiliation":[{"name":"National Center for Geriatrics and Welfare Research, National Health Research Institutes"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Kaohsiung Medical University Hospital, Kaohsiung Medical University"},{"name":"National Center for Geriatrics and Welfare Research, National Health Research Institutes"},{"name":"National Sun Yat-sen University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"S1478951526102636_ref39","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.V46N3p84"},{"key":"S1478951526102636_ref44","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2018.05.020"},{"key":"S1478951526102636_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbs161"},{"key":"S1478951526102636_ref38","doi-asserted-by":"publisher","DOI":"10.1177\/0269216319854264"},{"key":"S1478951526102636_ref17","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.382"},{"key":"S1478951526102636_ref37","doi-asserted-by":"publisher","DOI":"10.1177\/02692163241284088"},{"key":"S1478951526102636_ref24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2011.05659.x"},{"key":"S1478951526102636_ref6","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9111477"},{"key":"S1478951526102636_ref21","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-019-1040-3"},{"key":"S1478951526102636_ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-020-01920-1"},{"key":"S1478951526102636_ref31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0116629"},{"key":"S1478951526102636_ref11","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004763"},{"key":"S1478951526102636_ref41","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-33330-0_1"},{"key":"S1478951526102636_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2020.12.018"},{"key":"S1478951526102636_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.10.003"},{"key":"S1478951526102636_ref23","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afx162"},{"key":"S1478951526102636_ref54","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnaa036"},{"key":"S1478951526102636_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2015.01.008"},{"key":"S1478951526102636_ref8","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-020-01801-7"},{"key":"S1478951526102636_ref7","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-022-03287-x"},{"key":"S1478951526102636_ref32","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18511"},{"key":"S1478951526102636_ref34","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211042530"},{"key":"S1478951526102636_ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2021.104616"},{"key":"S1478951526102636_ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.zefq.2023.05.018"},{"key":"S1478951526102636_ref49","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igx025"},{"key":"S1478951526102636_ref15","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.55.6924"},{"key":"S1478951526102636_ref30","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199901000-00003"},{"key":"S1478951526102636_ref48","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-048232"},{"key":"S1478951526102636_ref14","doi-asserted-by":"publisher","DOI":"10.1177\/0969733019833130"},{"key":"S1478951526102636_ref10","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06548-4"},{"key":"S1478951526102636_ref50","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13526"},{"key":"S1478951526102636_ref26","article-title":"Frailty among older patients receiving home care services","volume":"141","author":"Krogseth","year":"2021","journal-title":"Tidsskr den nor Laegeforening"},{"key":"S1478951526102636_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2014.07.010"},{"key":"S1478951526102636_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.pecinn.2023.100241"},{"key":"S1478951526102636_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2014.01.008"},{"key":"S1478951526102636_ref22","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2021.27.9.471"},{"key":"S1478951526102636_ref25","doi-asserted-by":"publisher","DOI":"10.1186\/s41687-022-00457-8"},{"key":"S1478951526102636_ref29","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17217954"},{"key":"S1478951526102636_ref28","doi-asserted-by":"publisher","DOI":"10.3390\/geriatrics3030043"},{"key":"S1478951526102636_ref33","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afac224"},{"key":"S1478951526102636_ref42","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16104"},{"key":"S1478951526102636_ref5","volume-title":"National Guidebook for Dementia Palliative Care in Taiwan","author":"Chen","year":"2024"},{"key":"S1478951526102636_ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.10.367"},{"key":"S1478951526102636_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzab075"},{"key":"S1478951526102636_ref2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15049"},{"key":"S1478951526102636_ref12","first-page":"305","article-title":"The level of emotion control, anxiety, and self-efficacy in the elderly in Bialystok, Poland","volume":"12","author":"Cybulski","year":"2017","journal-title":"Clin IntervAging"},{"key":"S1478951526102636_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2009.10.004"},{"key":"S1478951526102636_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(94)90129-5"},{"key":"S1478951526102636_ref19","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18020417"},{"key":"S1478951526102636_ref45","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14467"},{"key":"S1478951526102636_ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.12.331"},{"key":"S1478951526102636_ref51","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2019.01.008"},{"key":"S1478951526102636_ref53","doi-asserted-by":"publisher","DOI":"10.1177\/08258597211051208"},{"key":"S1478951526102636_ref55","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11101478"},{"key":"S1478951526102636_ref52","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19095358"}],"updated-by":[{"DOI":"10.1017\/s1478951526103022","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000}}],"container-title":["Palliative and Supportive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1478951526102636","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T12:11:51Z","timestamp":1785499911000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1478951526102636\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":55,"alternative-id":["S1478951526102636"],"URL":"https:\/\/doi.org\/10.1017\/s1478951526102636","relation":{},"ISSN":["1478-9515","1478-9523"],"issn-type":[{"value":"1478-9515","type":"print"},{"value":"1478-9523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e151"}}