Lin Kang1, Xiao-Hong Liu2, Jing Zhang3, Pei-Yan Shan4, Jie-Ping Wang5, Ping Zhong6, Xiao-Hong Du7, Yu-Feng Du8, Bao-Cheng Yu9, Nan Wei10, Hui-Ling Lou11, Ou Bian12, Huai-Hong Chen13, Fan Lin14, Hong-Lian Zhou15, Wen He16, Huai-Cong Long17, Lu-Rong Hong18, Hui Su19, Jun-Nan Yang20, Yong-Liang Jiang21, Ye Shi22, Jing Ning23, Fang Liang24, Zhong Wang25, Ting Gong26, Ming-Lei Zhu1, Xiao-Hong Ning1, Zhi-Jun Chen27, Liang-Kung Chen28. 1. Geriatrics Department, Peking Union Medical College Hospital, Beijing, China. 2. Geriatrics Department, Peking Union Medical College Hospital, Beijing, China. Electronic address: xhliu41@medmail.com.cn. 3. Geriatrics Department, Dalian Friendship Hospital, Dalian, China. 4. Geriatrics Department, Qilu Hospital, Shandong University, Jinan, China. 5. Geriatrics Department, Fuxing Hospital, Capital Medical University, Beijing, China. 6. Geriatrics Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China. 7. Geriatrics Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. 8. Geriatrics Department, First Hospital of Shanxi Medical University, Taiyuan, China. 9. Geriatrics Department, Bethune International Peace Hospital, Shijiazhuang, China. 10. VIP Ward, First Affiliated Hospital of Harbin Medical University, Harbin, China. 11. Geriatrics Department, Guang Zhou First People's Hospital, Guangzhou, China. 12. Department No.1 Cadre Ward, Shenyang Military Command General Hospital, China. 13. Geriatrics Department, Zhejiang Hospital, Hangzhou, China. 14. Geriatrics Department, Fujian Provincial Hospital, Fuzhou, China. 15. Geriatrics Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China. 16. Geriatrics Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 17. Geriatric Intensive Care Unit, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China. 18. Geriatrics Department, Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, China. 19. Geriatrics Department, Xijing Hospital, Fourth Military Medical University, Xian, China. 20. Geriatrics Department, Peking University Shougang Hospital, Beijing, China. 21. Geriatrics Department, Hunan Provincial People's Hospital, Changsha, China. 22. Geriatrics Department, Shaanxi Provincial People's Hospital, Xian, China. 23. Geriatrics Department, Ninth People's Hospital, Zhengzhou, China. 24. Geriatrics Department No. 3, First Hospital of Shijiazhuang, Shijiazhuang, China. 25. Geriatrics Department, Chengdu Fifth People's Hospital, Chengdu, China. 26. Cadre Ward Department, The PLA 401 Hospital, Qingdao, Shandong, China. 27. Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan. 28. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address: lkchen2@vghtpe.gov.tw.
Abstract
OBJECTIVES: Chinese people are generally unfamiliar with the concept of advance care planning or advance directives (ACP/ADs), which raises dilemmas in life-support choice and can even affect clinical decision making. To understand and address the issues involved better, we investigated the awareness of ACP/ADs in China, as well as people's attitudes toward medical autonomy and end-of-life care. DESIGN: A multicenter cross-sectional survey, conducted from August 1 to December 31, 2016. SETTING: Twenty-five hospitals located in 15 different provinces throughout mainland China. PARTICIPANTS: Pairs of adult patients without dementia or malignancies, and a family member. MEASUREMENTS: Participants self-filled anonymous questionnaires, and the data collected were analyzed to relate patients' sociodemographic characteristics to their awareness of ACP/ADs and attitudes to health care autonomy and end-of-life care. RESULTS: Among 1084 patients who completed the questionnaire, 415 (38.3%) had heard about ACP/ADs. Having been informed about ACP/ADs, 995 (91.8%) were willing to find out their true health status and decide for themselves; 549 (50.6%) wanted to institute ACP/ADs. Regarding end-of-life care, 473 (43.6%) chose Do Not Resuscitate, and 435 (40.1%) wished to forgo life-support treatment if irreversibly moribund. Patients predominantly (481, 44.4%) chose general hospital as their preferred place to spend their last days of life; only 114 (10.5%) favored a special hospice facility. Patients' main concerns during end-of-life care were symptom control (35.1%), followed by functional maintenance and quality of life (29.8%), and prolonging life (18.9%). More highly educated patients had significantly greater awareness of ACP/ADs than less well educated ones (χ2 = 59.22, P < .001) and were more willing to find out the truth for themselves (χ2 = 58.30, P ≤ .001) and make medical decisions in advance (χ2 = 55.92, P < .001). Younger patients were also more willing than older ones to know the truth (χ2 = 38.23, P = .001) and make medical decisions in advance (χ2 = 18.42, P = .018), and were also more likely to wish to die at home (χ2 = 96.25, P < .001). Only 212 patients' family members (19.6%) wanted life-support treatment for themselves if irreversibly moribund, whereas 592 (54.6%) would want their relative to receive such procedures in the same circumstances; a similar discrepancy was evident for end-of-life invasive treatment (18.3% vs 42.7%). CONCLUSIONS: Awareness about ACP/ADs in China is still low. Providing culturally sensitive knowledge, education, and communication regarding ACP/ADs is a feasible first step to promoting this sociomedical practice.
OBJECTIVES: Chinese people are generally unfamiliar with the concept of advance care planning or advance directives (ACP/ADs), which raises dilemmas in life-support choice and can even affect clinical decision making. To understand and address the issues involved better, we investigated the awareness of ACP/ADs in China, as well as people's attitudes toward medical autonomy and end-of-life care. DESIGN: A multicenter cross-sectional survey, conducted from August 1 to December 31, 2016. SETTING: Twenty-five hospitals located in 15 different provinces throughout mainland China. PARTICIPANTS: Pairs of adult patients without dementia or malignancies, and a family member. MEASUREMENTS: Participants self-filled anonymous questionnaires, and the data collected were analyzed to relate patients' sociodemographic characteristics to their awareness of ACP/ADs and attitudes to health care autonomy and end-of-life care. RESULTS: Among 1084 patients who completed the questionnaire, 415 (38.3%) had heard about ACP/ADs. Having been informed about ACP/ADs, 995 (91.8%) were willing to find out their true health status and decide for themselves; 549 (50.6%) wanted to institute ACP/ADs. Regarding end-of-life care, 473 (43.6%) chose Do Not Resuscitate, and 435 (40.1%) wished to forgo life-support treatment if irreversibly moribund. Patients predominantly (481, 44.4%) chose general hospital as their preferred place to spend their last days of life; only 114 (10.5%) favored a special hospice facility. Patients' main concerns during end-of-life care were symptom control (35.1%), followed by functional maintenance and quality of life (29.8%), and prolonging life (18.9%). More highly educated patients had significantly greater awareness of ACP/ADs than less well educated ones (χ2 = 59.22, P < .001) and were more willing to find out the truth for themselves (χ2 = 58.30, P ≤ .001) and make medical decisions in advance (χ2 = 55.92, P < .001). Younger patients were also more willing than older ones to know the truth (χ2 = 38.23, P = .001) and make medical decisions in advance (χ2 = 18.42, P = .018), and were also more likely to wish to die at home (χ2 = 96.25, P < .001). Only 212 patients' family members (19.6%) wanted life-support treatment for themselves if irreversibly moribund, whereas 592 (54.6%) would want their relative to receive such procedures in the same circumstances; a similar discrepancy was evident for end-of-life invasive treatment (18.3% vs 42.7%). CONCLUSIONS: Awareness about ACP/ADs in China is still low. Providing culturally sensitive knowledge, education, and communication regarding ACP/ADs is a feasible first step to promoting this sociomedical practice.
Authors: Zoe Wan; Helen Y L Chan; Patrick K C Chiu; Raymond S K Lo; Hui-Lin Cheng; Doris Y P Leung Journal: Int J Environ Res Public Health Date: 2022-04-28 Impact factor: 4.614