Comparative Efficacy of Interventions for Burnout in Physician Residents: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Heart failure represents the end stage of various cardiac diseases. Patients with end-stage heart failure (ESHF) experience recurrent conditions, poor prognoses, and high mortality rates, often facing urgent medical decisions and risks of futile treatment (). Advance care planning (ACP) refers to the process in which patients, while conscious, discuss their future medical preferences, treatment goals, and care wishes with healthcare providers and family members (). It safeguards patients’ autonomy, improves the quality of end-of-life care, and reduces the waste of medical resources (, ). In recent years, ACP has been gradually promoted in the field of end-stage chronic diseases in China (). However, the acceptance of ACP among ESHF patients remains generally low (). Quantitative studies have mostly revealed correlations between influencing factors but failed to explain the deep-seated cultural and psychological mechanisms underlying decision-making. The purpose of this study is to explore the deep-seated reasons for low ACP acceptance among ESHF patients and to provide a theoretical basis for the construction of cultural-adapted intervention programs. Internationally, ACP has been widely applied in patients with malignant tumors, renal diseases, heart failure and other end-stage diseases, and its effectiveness in improving the quality of end-of-life care has been widely confirmed (, , ). However, most relevant studies are based on Western individual-oriented cultural backgrounds, and their conclusions cannot be directly extended to China’s family-oriented medical decision-making model.