{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T03:40:11Z","timestamp":1788234011237,"version":"build-2803163510"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Lishui Science and Technology Bureau","award":["2024GYX62"],"award-info":[{"award-number":["2024GYX62"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To assess the implementation and barriers of Advance Care Planning (ACP) from the perspectives of nurses, patients, and family members in a Chinese healthcare setting, providing evidence for targeted interventions to enhance ACP awareness.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A mixed-methods design combined a cross-sectional survey and qualitative interviews. Questionnaires measured ACP-related knowledge, attitudes, practices (KAP), and perceived barriers among 843 nurses, 384 patients, and 857 family members. Based on responses, 15 patients and 20 family members with negative views on ACP were invited for semi-structured interviews and focus groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>Nurses rated ACP as highly important and reported effective palliative care practices, while patients and families showed substantial cognitive gaps. Over 90% of patients valued ACP, but only ~30% believed it was well implemented; many families associated it with treatment abandonment. Multivariable analysis identified hospital type, clinical experience, and information sources as KAP predictors. Qualitative results linked misconceptions to poor communication and insufficient public education.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Nurses endorse ACP, but patients and families often misinterpret it as giving up treatment. Improved communication and tailored education are critical to increasing ACP acceptance in China.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333739","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T17:40:34Z","timestamp":1759858834000},"page":"e0333739","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Nurses\u2019 high valuation of palliative care versus patient and family misconceptions: A mixed-approach study of Advanced Care Planning implementation in China"],"prefix":"10.1371","volume":"20","author":[{"given":"Chenyan","family":"Liang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzhen","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leiwen","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"issue":"1","key":"pone.0333739.ref001","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s12904-024-01533-0","article-title":"Acceptance level of advance care planning and its associated factors among the public: a nationwide survey","volume":"23","author":"X Wang","year":"2024","journal-title":"BMC Palliat Care"},{"issue":"1","key":"pone.0333739.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7475\/kjan.2024.36.1.1","article-title":"The application of theories in research on advance care planning (2010~2022): a scoping review","volume":"36","author":"J Shin","year":"2024","journal-title":"Korean J Adult Nurs"},{"issue":"4","key":"pone.0333739.ref003","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1177\/0825859718763644","article-title":"Advance care planning in chinese seniors: cultural perspectives","volume":"33","author":"HWB Cheng","year":"2018","journal-title":"J Palliat Care"},{"issue":"1","key":"pone.0333739.ref004","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1111\/j.1748-720X.1993.tb01235.x","article-title":"The impact of the patient self-determination act\u2019s requirement that states describe law concerning patients\u2019 rights","volume":"21","author":"JM Teno","year":"1993","journal-title":"J Law Med Ethics"},{"issue":"1","key":"pone.0333739.ref005","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1186\/s12913-021-06773-x","article-title":"Positive attitudes to advance care planning - a Norwegian general population survey","volume":"21","author":"TJL S\u00e6vareid","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"5","key":"pone.0333739.ref006","doi-asserted-by":"crossref","first-page":"3241","DOI":"10.5194\/acp-24-3241-2024","article-title":"Measurement report: atmospheric ice nuclei in the Changbai Mountains (2623\u2009m\u2009a.s.l.) in northeastern Asia","volume":"24","author":"Y Sun","year":"2024","journal-title":"Atmos Chem Phys"},{"issue":"10","key":"pone.0333739.ref007","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1089\/jpm.2019.0398","article-title":"Acceptability, feasibility, and efficacy potential of a multimodal acceptance and commitment therapy intervention to address psychosocial and advance care planning needs among anxious and depressed adults with metastatic cancer","volume":"23","author":"JJ Arch","year":"2020","journal-title":"J Palliat Med"},{"key":"pone.0333739.ref008","doi-asserted-by":"crossref","first-page":"100069","DOI":"10.1016\/j.ijnsa.2022.100069","article-title":"The \u201cgood death\u201d in Mainland China - a scoping review","volume":"4","author":"C Fu","year":"2022","journal-title":"Int J Nurs Stud Adv"},{"issue":"4","key":"pone.0333739.ref009","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1093\/jmp\/jhv016","article-title":"Medical individualism or medical familism? 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