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Ye L, Jin G, Chen M, Xie X, Shen S, Qiao S. Prevalence and factors of discordance attitudes toward advance care planning between older patients and their family members in the primary medical and healthcare institution. Front Public Health 2023; 11:1013719. [PMID: 36908464 PMCID: PMC9996283 DOI: 10.3389/fpubh.2023.1013719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background This study aimed at investigating the prevalence and factors of the discordant attitudes toward advance care planning (ACP) among older patients and their family members toward patients' engagement in ACP in the primary medical and healthcare institution. Methods In a cross-sectional study, a total of 117 older patients and 117 family members from Jinhua Fifth Hospital in China were enrolled. The questionnaire included sociodemographic characteristics, functional capacity assessment, and attitudes toward patients' engagement in ACP. Functional capacity assessment scales included the Modified Barthel Index (MBI), the Short-Form Mini-Nutritional Assessment (MNA-SF), the 15-item Geriatric Depression Scale (GDS-15), the Mini-Mental State Examination (MMSE), the Clinical Frailty Scale (CFS), and the SARC-F questionnaire. Results The discordance attitudes toward patients' engagement in ACP between patients and family members accounted for 41(35.0%). In the multivariate logistic analysis, factors associated with higher odds of discordance attitudes toward patients' engagement in ACP included greater age differences between patients and family members (OR = 1.043, 95% CI: 1.007-1.081), lower educational level for family members (OR = 3.373, 95% CI: 1.239-9.181), the patient's higher GDS-15 score (OR = 1.437, 95% CI: 1.185-1.742), and patient's higher MNA-SF score (OR = 1.754, 95% CI: 1.316-2.338). Conclusion Older patients and their family members had little ACP knowledge, and factors that influence discordance attitudes toward patients' engagement in ACP included the age gaps between patients and family members, family members' educational level, patients' depressive symptoms, and patients' nutritional status.
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Affiliation(s)
- Ling Ye
- Department of Geriatrics, Jinhua Fifth Hospital, Jinhua, China
| | - Genhong Jin
- Department of Geriatrics, Jinhua Fifth Hospital, Jinhua, China
| | - Min Chen
- Department of Geriatrics, Jinhua Fifth Hospital, Jinhua, China
| | - Xingyuan Xie
- Department of Geriatrics, Jinhua Fifth Hospital, Jinhua, China
| | - Shanshan Shen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, China
| | - Song Qiao
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
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Zhang RR, Xu Y, Zhao YP. Perspective on advanced directives among older adults in Shanghai: A qualitative study. Int J Nurs Sci 2022; 10:46-52. [PMID: 36860709 PMCID: PMC9969170 DOI: 10.1016/j.ijnss.2022.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/17/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Objective This study aimed to explore the perception on advanced directives (ADs) among older adults in Shanghai. Methods Through purposive sampling, 15 older adults with rich life experiences who were willing to share perceptions and experiences of ADs participated in this study. Face-to-face semi-structured interviews were conducted to collect the qualitative data. Thematic content analysis was applied to analyze the data. Results Five themes have been identified: low awareness but high acceptance of ADs; pursuing natural and peaceful sunset life; ambiguous attitude on medical autonomy; being irrational facing patients' dying and death issues; positive about implementing ADs in China. Conclusion It is possible and feasible to implement ADs in older adults. Death education and compromised medical autonomy may be needed in the Chinese context as the foundation. The elder's understanding, willingness and worries about ADs should be fully revealed. Diverse approaches should be applied to introduce and interpret ADs to older adults continuously.
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Liu CJ, Yang CY, Hsieh MH, Liu CK, Chen MC, Huang SJ, Yeh TC. Advance Care Planning Among Adult Patients and Their End-of-Life Care Preferences. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221143687. [PMID: 36460356 DOI: 10.1177/00302228221143687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
To explore people's intentions to opt for a good death when planning for their end-of-life care, this study examined the type of end-of-life care preferred by patients receiving advance care planning (ACP) consulting services for five specified clinical and disability conditions and possible factors affecting their decision-making. This cross-sectional study analyzed 1303 hospital patients and 1032 nonhospital patients who attended a clinic providing ACP consulting services. This study revealed the following two results. First, patients who were older, were female, did not have an appointed surrogate decision-maker, and were nonhospital patients had a higher intention of not receiving life-sustaining treatments (LST) or artificial nutrition and hydration (ANH) under the five specified clinical and disability conditions. Second, people who were the least willing to receive LST or ANH under the following conditions (in descending order): permanent vegetative state, severe dementia, irreversible coma, other disease conditions recognized by the central competent authority, and end-of-life stage.
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Affiliation(s)
- Chia-Jen Liu
- Department of Health and Welfare, University of Taipei, Taipei, Taiwan
- Center for General Education, Taipei University of Marine Technology, Taipei, Taiwan
| | - Chun-Yi Yang
- Department of Health and Welfare, University of Taipei, Taipei, Taiwan
- Department of Social Work, Taipei City Hospital, Taipei, Taiwan
| | - Ming-Hsuan Hsieh
- Development and Planning Center, Taipei City Hospital, Taipei, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
| | - Chih-Kuang Liu
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
| | - Ming-Chih Chen
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
| | - Sheng-Jean Huang
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Te-Chun Yeh
- Center for General Education, Taipei University of Marine Technology, Taipei, Taiwan
- Development and Planning Center, Taipei City Hospital, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
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HU C, ZHAO C, LAI P, WANG X, LIANG Z. The effect of refined nursing applied in the nursing room of thoracoscopic lung cancer radical operation in Southwestern China. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.46321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Ping LAI
- People's Hospital of Deyang City, China
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Martina D, Geerse OP, Lin CP, Kristanti MS, Bramer WM, Mori M, Korfage IJ, van der Heide A, Rietjens JAC, van der Rijt CCD. Asian patients' perspectives on advance care planning: A mixed-method systematic review and conceptual framework. Palliat Med 2021; 35:1776-1792. [PMID: 34488509 PMCID: PMC8637390 DOI: 10.1177/02692163211042530] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Asian healthcare professionals hold that patients' families play an essential role in advance care planning. AIM To systematically synthesize evidence regarding Asian patients' perspectives on advance care planning and their underlying motives. DESIGN Mixed-method systematic review and the development of a conceptual framework (PROSPERO: CRD42018099980). DATA SOURCES EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for studies published until July 27, 2020. We included studies concerning seriously-ill Asian patients' perspectives on advance care planning or their underlying motives for engaging or not engaging in it. RESULTS Thirty-six articles were included; 22 were quantitative and 27 were from high-income countries. Thirty-nine to ninety percent of Asian patients were willing to engage in advance care planning. Our framework highlighted that this willingness was influenced not only by their knowledge of their disease and of advance care planning, but also by their beliefs regarding: (1) its consequences; (2) whether its concept was in accordance with their faith and their families' or physicians' wishes; and (3) the presence of its barriers. Essential considerations of patients' engagement were their preferences: (1) for being actively engaged or, alternatively, for delegating autonomy to others; (2) the timing, and (3) whether or not the conversations would be documented. CONCLUSION The essential first step to engaging patients in advance care planning is to educate them on it and on their diseases. Asian patients' various beliefs about advance care planning should be accommodated, especially their preferences regarding their role in it, its timing, and its documentation.
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Affiliation(s)
- Diah Martina
- Department of Medical Oncology, Erasmus
MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The
Netherlands
- Department of Public Health, Erasmus
MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Psychosomatic and
Palliative Medicine, Department of Internal Medicine, Universitas Indonesia,
Jakarta, Indonesia
- Dr. Cipto Mangunkusumo National Center
Hospital, Jakarta, Indonesia
| | - Olaf P Geerse
- Department of Internal Medicine,
Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Cheng-Pei Lin
- Institute of Community Health Care,
School of Nursing, National Yang Ming Chiao Tung University, Taipei
- Florence Nightingale Faculty of
Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative
Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Martina S Kristanti
- School of Nursing, Faculty of Medicine,
Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University
Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Masanori Mori
- Palliative and Supportive Care
Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Ida J Korfage
- Department of Public Health, Erasmus
MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus
MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith AC Rietjens
- Department of Public Health, Erasmus
MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carin CD van der Rijt
- Department of Medical Oncology, Erasmus
MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The
Netherlands
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Ding CQ, Jin JF, Lan MJ, Zhang YP, Wang YW, Yang MF, Wang S. Do-not-resuscitate decision making for terminally ill older patients in the emergency department: An explorative, descriptive inquiry of Chinese family members. Geriatr Nurs 2021; 42:843-849. [PMID: 34090229 DOI: 10.1016/j.gerinurse.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
Many terminally ill older adults depend on family members to make medical decisions in China. Many family members find it difficult to make do-not-resuscitate (DNR) decisions in emergency departments (ED). Currently, factors that affect DNR decision making by family members for older adults needing emergency care have not been well studied. This qualitative inquiry explores factors influencing DNR decision-making among family members of terminally ill older adults in ED. Semi-structured in-depth interviews were conducted for a 12-family member of terminally ill older adults at ED in China. Results of the conventional content analysis showed that family members made DNR decisions based on a wide of reasons: (a) subjective perception of family members, (b) conditions of the terminally ill older adults, (c) external environmental factors, and (d) internal family factors. The findings of this study expand our knowledge and understanding of factors influencing DNR decision-making by family members of terminally ill older adults in ED.
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Affiliation(s)
- Chuan-Qi Ding
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China; Changxing Branch Hospital of SAHZU, Huzhou, Zhejiang Province, PR China
| | - Jing-Fen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China; Changxing Branch Hospital of SAHZU, Huzhou, Zhejiang Province, PR China.
| | - Mei-Juan Lan
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
| | - Yu-Ping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
| | - Yu-Wei Wang
- Department of Emergency Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
| | - Min-Fei Yang
- Department of Emergency Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
| | - Sa Wang
- Department of Emergency Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
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