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advance care planning, advance directives, community, end-of-life care, older adults



  1. Jo, Minjeong PhD, RN
  2. Park, Mihyun PhD, RN
  3. Park, Eun-Jun PhD, RN
  4. Choi, Ji Yeon MEd, RN


This study was a preliminary study that assessed the acceptability of a communication-based advance care planning (ACP) intervention for older adults to improve decision making for treatment at the end of life. Twenty dyads were recruited, including patients who were older than 65 years and registered in a home health care center of a teaching hospital in South Korea and their surrogates. The intervention is a patient-centered ACP program with surrogates and a structured and guided discussion by home health care nurses as the trained interventionists. The acceptability of the intervention was assessed by a mixed method including a survey and a structured interview with participants. Findings in this study indicate that recruiting older adults with chronic diseases and their surrogates in a home health care center and conducting the intervention by home health care nurses is feasible. In addition, the outcomes of this study suggest that the intervention may have a potential impact on end-of-life care decision making for older adults in South Korea. A larger-scale trial is required to determine the effects of the ACP program when implemented with various groups. This study suggests that older adults need an ACP program as part of routine care.