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Background <p>Advance care planning (ACP) is increasingly recognized as important for adolescents and young adults (AYAs) with cancer, yet evidence on their ACP participation remains fragmented and largely interpreted through adult-oriented models. This mixed-methods systematic review aimed to synthesize the current status of ACP participation among AYAs with cancer and the factors influencing this process.</p> Methods <p>PubMed, Embase, Web of Science, CINAHL, and the Cochrane Library were searched from inception to January 2026. Qualitative, quantitative, and mixed-methods studies involving AYAs with cancer were included. Study quality was appraised using the Mixed Methods Appraisal Tool, and findings were synthesized using a convergent integrated approach.</p> Results <p>Fifteen studies involving 825 participants were included. ACP participation among AYAs with cancer was characterized by family-consensus-oriented decision-making, psychologically ambivalent and evolving experiences, and a gap between family preparedness and clinical implementation. Structured ACP tools facilitated family discussions and preference documentation, but communication with healthcare professionals remained limited and intervention effects attenuated over time. Participation was promoted by perceived benefits, illness-related triggers, family support, trusting clinician relationships, age-appropriate communication, and organizational support, whereas death anxiety, emotional avoidance, low self-efficacy, low perceived susceptibility, communication barriers, limited professional competence, cultural taboos, and inequities impeded engagement.</p> Conclusion <p>ACP participation among AYAs with cancer is a dynamic, relational, and developmentally embedded process rather than a one-time autonomous decision. Future practice should adopt age-appropriate, family-sensitive, and clinically integrated approaches that support repeated ACP conversations across the illness trajectory.</p> Trial registration <p>This review was registered in PROSPERO on April 21, 2025 under registration number CRD420251037008.</p>

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Current status of and factors influencing advance care planning participation among adolescents and young adults with cancer: a mixed-methods systematic review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月3日

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  • Shen Kaibo,
  • He Sheng,
  • Huang Baolin,
  • Ju Zhang

摘要

Background

Advance care planning (ACP) is increasingly recognized as important for adolescents and young adults (AYAs) with cancer, yet evidence on their ACP participation remains fragmented and largely interpreted through adult-oriented models. This mixed-methods systematic review aimed to synthesize the current status of ACP participation among AYAs with cancer and the factors influencing this process.

Methods

PubMed, Embase, Web of Science, CINAHL, and the Cochrane Library were searched from inception to January 2026. Qualitative, quantitative, and mixed-methods studies involving AYAs with cancer were included. Study quality was appraised using the Mixed Methods Appraisal Tool, and findings were synthesized using a convergent integrated approach.

Results

Fifteen studies involving 825 participants were included. ACP participation among AYAs with cancer was characterized by family-consensus-oriented decision-making, psychologically ambivalent and evolving experiences, and a gap between family preparedness and clinical implementation. Structured ACP tools facilitated family discussions and preference documentation, but communication with healthcare professionals remained limited and intervention effects attenuated over time. Participation was promoted by perceived benefits, illness-related triggers, family support, trusting clinician relationships, age-appropriate communication, and organizational support, whereas death anxiety, emotional avoidance, low self-efficacy, low perceived susceptibility, communication barriers, limited professional competence, cultural taboos, and inequities impeded engagement.

Conclusion

ACP participation among AYAs with cancer is a dynamic, relational, and developmentally embedded process rather than a one-time autonomous decision. Future practice should adopt age-appropriate, family-sensitive, and clinically integrated approaches that support repeated ACP conversations across the illness trajectory.

Trial registration

This review was registered in PROSPERO on April 21, 2025 under registration number CRD420251037008.