{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:46:46Z","timestamp":1792241206872,"version":"4.4.0"},"reference-count":72,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To examine advance care planning (ACP) participation among older adults with Alzheimer's disease (AD), their family caregivers, and healthcare professionals in China, and to identify key influencing factors and challenges from a stakeholder perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross\u2010sectional survey guided by stakeholder theory. The study was reported in accordance with the The STROBE checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional study was conducted from December 2024 to July 2025 in two tertiary hospitals and one social welfare center in Hangzhou, China. Convenience sampling was used to recruit healthcare professionals, older adults with early\u2010stage AD, and family caregivers of AD patients. Structured questionnaires assessed ACP preparedness or participation. Data were analysed using descriptive statistics, correlation analyses, and multiple linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Healthcare professionals demonstrated high ACP knowledge and positive attitudes but low engagement in ACP\u2010related behaviours. Older adults with early\u2010stage AD showed moderate ACP preparedness, characterized by strong beliefs and motivation but relatively low attitudinal readiness. Family caregivers reported moderate\u2010to\u2010high ACP participation while experiencing substantial decision conflict. Stakeholder theory was used to interpret group differences in ACP preparedness, participation, and decision conflict. The findings reflect inherent disparities in decision\u2010making power, accessible resources, and interest demands among patients, family caregivers, and healthcare professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ACP participation in Chinese families affected by AD remains fragmented and structurally constrained. Although stakeholders recognize ACP's value, disparities in roles, resources, and power hinder patient\u2010centered decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Clinical Practice<\/jats:title>\n                    <jats:p>This study provides references for the clinical implementation of Advance Care Planning (ACP) for dementia patients, the construction of multidisciplinary collaboration models, and the development of caregiver support strategies in the Chinese cultural context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient and Public Contribution<\/jats:title>\n                    <jats:p>Healthcare professionals, patients, and family members participated in data collection, providing comprehensive empirical evidence on ACP\u2010related attitudes, behaviours, and decision conflicts for the study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocn.70604","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:25:08Z","timestamp":1792239908000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patterns of Stakeholder Participation in Advance Care Planning for Older Adults With Alzheimer's Disease in China: A Cross\u2010Sectional Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7591-6814","authenticated-orcid":false,"given":"Sijie","family":"Wang","sequence":"first","affiliation":[{"name":"School of Nursing Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Nursing Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Metabolic Diseases Boao Campus, The Second Affiliated Hospital Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingli","family":"He","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province)  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Hematology The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5356-0226","authenticated-orcid":false,"given":"Minmin","family":"Shi","sequence":"additional","affiliation":[{"name":"School of Nursing Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18137150"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0714980821000283"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afad027"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317722413"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4192-0"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.70983"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-022-04106-8"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1672\u20101756.2019.03.004"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2018.1461192"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1201\/9781315183084"},{"key":"e_1_2_13_12_1","volume-title":"Strategic Management: A Stakeholder Approach","author":"Freeman R. 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