Advance directives and end-of-life care preferences among adults in Wuhan, China: a cross-sectional study

Factors Associated with Patient-Caregiver Concordance about Life-Sustaining Treatment Preferences among Advanced Cancer Patients: A Cross-Sectional Study

OBJECTIVES

Concordance of preferences for end-of-life care regarding patients between patients with advanced cancer and family caregivers can improve the likelihood of honoring dying patients' wishes. However, there is a dearth of knowledge in mainland China. The purpose of this study was to examine patient-family caregiver concordance about patients' life-sustaining treatment preferences and associated factors among patients with advanced cancer in China.

METHODS

From September 2019 to December 2021, a convenience sample of 406 dyads of advanced cancer patient-family caregiver were recruited from 2 tertiary hospitals in Wuhan, China. Participants completed a questionnaire about patient's preferences for life-sustaining treatment, respectively. The concordance was assessed by percent agreement and kappa coefficients. Associated factors were identified by univariate analysis and binary logistic regression.

RESULTS

The average concordance rate on the preferences for life-sustaining treatment was 56.1%, ranging from 52.9% to 59.3%. Factors associated with a higher level of patient-family caregiver concordance were following: patients who were married, whose educational levels were at college or above, who had not been informed of diagnosis by a physician, who had been informed of the effects and side effects of related drugs by a physician, and who cared for a seriously ill family member or friend and caregivers whose educational level were primary or below.

CONCLUSIONS

The patient-family caregiver concordance about patients' life-sustaining treatment preferences among patients with advanced cancer was poor. Patients' and caregivers' understanding of life-sustaining treatment and its efficacy in end-of-life should be facilitated. Relevant conversation should be encouraged between patients and caregivers, thus providing value-concordant end-of-life care for patients with cancer.

IMPLICATIONS FOR NURSING PRACTICE

Health professionals need to carry out advanced care planning in oncology departments on mainland China to encourage patients and caregivers to discuss patients' end-of-life care preferences. Facilitating patients' and caregivers' understanding of life-sustaining treatment preferences may help improve the patient-caregiver concordance on life-sustaining treatment preferences among patients with advanced cancer.

End-of-Life Medical Decisions: The Link Between Sociodemographic Characteristics and Treatment Preferences

INTRODUCTION

Advance directives (ADs) promote patient autonomy in end-of-life (EOL) care, including an individual's EOL medical treatment preferences. This study aims to better understand preferences regarding EOL medical treatment among community-dwelling adults (18 and older) residing in the United States and examine the association between sociodemographic characteristics and EOL medical treatment preferences.

METHODS

Utilizing a cross-sectional study and snowball sampling methodology, community-dwelling adults completed a survey containing two different ADs and a questionnaire with sociodemographic information. Univariate analyses were used to summarize EOL medical treatment preferences among the sample, and bivariate analyses (Chi-square and Fisher's Exact tests) were performed to examine the association between sociodemographic characteristics (age, gender, and race/ethnicity) and EOL medical treatment preferences.

RESULTS

The mean age of the 166 participants was 50 (SD: 21.65, range: 18-93), with 58.4% being White and 61.4% being female. Generally, when EOL scenarios involved brain damage or a coma, more participants indicated that they did not want life-support treatment. Age and race were both associated with EOL medical treatment preferences, but no significant differences were observed in the bivariate results by gender. Largely, young and middle-aged adults, along with Black participants, were more likely to prefer more aggressive EOL medical treatments than older adults and White participants.

CONCLUSION

Overall, EOL medical treatment preferences varied among participants. The study findings indicate that adults develop different preferences for EOL medical treatment, with some of the variation attributable to sociodemographic characteristics such as age and race.

Associations of health literacy, personality traits, and pro-individualism with the willingness to complete advance directives in Taiwan

BACKGROUND

Studies indicated that patients with advance directives (ADs) have a generally better quality of life near death. Yet, the concept of ADs is relatively new in East Asian countries. This study examined the associations between health literacy, pro-individualism in end-of-life (EOL) decisions (i.e., EOL pro-individualism), and master-persistence personality traits with the willingness to complete ADs.

METHODS

The data is from a representative data of 1478 respondents from the 2022 Taiwan Social Change Survey. Generalized structural equation modeling (GSEM) was used to conduct path analysis.

RESULTS

Nearly half of the respondents (48.7%) were willing to complete ADs. Health literacy has direct and indirect effects through EOL pro-individualism values on the willingness to complete ADs. Noncognitive factors such as mastery-persistence personality traits and EOL pro-individualism values enhanced the willingness to complete ADs.

CONCLUSION

A personalized communication strategy, mindful of personality dimensions and cultural values, can address individual fears and concerns, promoting the benefits of advance care planning (ACP). These influences can provide a roadmap for healthcare providers to customize their approach to ACP discussions, improving patient engagement in AD completion.

Psychometric Properties of the Sexual Compulsivity Scale in Men Who Have Sex with Men in Spanish Population

The Sexual Compulsivity Scale (SCS) has been translated, adapted and validated in general Spanish population, making its application difficult in certain groups, such as men who have sex with men (MSM). This paper evaluates the psychometric properties of the SCS in a sample of MSM in Spain. The SCS was administered to 881 participants. The factorial structure of the SCS was examined with an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Both EFA and CFA confirmed a two-factor structure: (1) Interference of sexual behavior, and (2) Failure to control sexual impulses. Internal consistency was really good for the scale and also for both factors. The SCS also presented adequate psychometric properties. Thus, it is an appropriate measure for assessing sexual compulsivity in MSM, and a tool to be taken into account in future researches to reduce sexual risk behaviors in the MSM Spanish population.

Advance care planning readiness for Chinese older people: An integrative review and conceptual framework

Advance care planning is a process of discussion in which patients can communicate their end-of-life care preferences to family members and health care providers for consideration. Readiness for advance care planning is a patient’s preparedness to engage in advance care planning. This review aims to develop the conceptual framework for advance care planning readiness for Chinese older people. The current knowledge from the published studies was identified and synthesized by an integrative review. The conceptual framework was developed based on the social-ecological model and the theory of planned behavior. The factors from the social environment/community, health care professionals, and individual/family layers were defined. These factors may influence an individual’s medical decision-making, which in turn triggers individual behavioral mechanisms that arise from interactions between motivations, attitudes, and beliefs. Relevant factors should be considered when assessing the behavior of personnel engaged in advance care planning or formulating appropriate intervention measures to improve advance care planning participation in China. This framework can be used to guide studies that explore how the social/familial/individual factors predict the readiness for advance care planning among Chinese older people, and to design intervention studies to test the effect of family function on the readiness for advance care planning.

Perspective on advanced directives among older adults in Shanghai: A qualitative study

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.