Patterns of Stakeholder Participation in Advance Care Planning for Older Adults With Alzheimer's Disease in China: A Cross‐Sectional Study

Abstract

ABSTRACT Aims 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. Design A cross‐sectional survey guided by stakeholder theory. The study was reported in accordance with the The STROBE checklist. Methods A cross‐sectional 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‐stage 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. Results Healthcare professionals demonstrated high ACP knowledge and positive attitudes but low engagement in ACP‐related behaviours. Older adults with early‐stage AD showed moderate ACP preparedness, characterized by strong beliefs and motivation but relatively low attitudinal readiness. Family caregivers reported moderate‐to‐high 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‐making power, accessible resources, and interest demands among patients, family caregivers, and healthcare professionals. Conclusions 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‐centered decision‐making. Implications for Clinical Practice 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. Patient and Public Contribution Healthcare professionals, patients, and family members participated in data collection, providing comprehensive empirical evidence on ACP‐related attitudes, behaviours, and decision conflicts for the study.