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Wu YL, Lin TW, Yang CY, Wang SSC, Huang SJ. Urban people's preferences for life-sustaining treatment or artificial nutrition and hydration in advance decisions. BMC Med Ethics 2024; 25:59. [PMID: 38762493 PMCID: PMC11102251 DOI: 10.1186/s12910-024-01060-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/08/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The Patient Right to Autonomy Act (PRAA), implemented in Taiwan in 2019, enables the creation of advance decisions (AD) through advance care planning (ACP). This legal framework allows for the withholding and withdrawal of life-sustaining treatment (LST) or artificial nutrition and hydration (ANH) in situations like irreversible coma, vegetative state, severe dementia, or unbearable pain. This study aims to investigate preferences for LST or ANH across various clinical conditions, variations in participant preferences, and factors influencing these preferences among urban residents. METHODS Employing a survey of legally structured AD documents and convenience sampling for data collection, individuals were enlisted from Taipei City Hospital, serving as the primary trial and demonstration facility for ACP in Taiwan since the commencement of the PRAA in its inaugural year. The study examined ADs and ACP consultation records, documenting gender, age, welfare entitlement, disease conditions, family caregiving experience, location of ACP consultation, participation of second-degree relatives, and the intention to participate in ACP. RESULTS Data from 2337 participants were extracted from electronic records. There was high consistency in the willingness to refuse LST and ANH, with significant differences noted between terminal diseases and extremely severe dementia. Additionally, ANH was widely accepted as a time-limited treatment, and there was a prevalent trend of authorizing a health care agent (HCA) to make decisions on behalf of participants. Gender differences were observed, with females more inclined to decline LST and ANH, while males tended towards accepting full or time-limited treatment. Age also played a role, with younger participants more open to treatment and authorizing HCA, and older participants more prone to refusal. CONCLUSION Diverse preferences in LST and ANH were shaped by the public's current understanding of different clinical states, gender, age, and cultural factors. Our study reveals nuanced end-of-life preferences, evolving ADs, and socio-demographic influences. Further research could explore evolving preferences over time and healthcare professionals' perspectives on LST and ANH decisions for neurological patients..
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Affiliation(s)
- Yi-Ling Wu
- Master's Program of Transition and Leisure Education for Individuals With Disabilities, University of Taipei, Taipei, Taiwan
| | - Tsai-Wen Lin
- National Academy Educational Research, Taipei, Taiwan
| | - Chun-Yi Yang
- Department of Social Work, Taipei City Hospital, Taipei, Taiwan
- Department of Health and Welfare, University of Taipei, Taipei, Taiwan
| | | | - Sheng-Jean Huang
- Department of Surgery, Medical College, National Taiwan University Hospital, Taipei, Taiwan
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Da C, Duan Y, Ji Z, Chen J, Xia H, Weng Y, Zhou T, Yuan C, Cai T. Assessing the needs of patients with breast cancer and their families across various treatment phases using a Latent Dirichlet Allocation model: a text-mining approach to online health communities. Support Care Cancer 2024; 32:314. [PMID: 38683417 DOI: 10.1007/s00520-024-08513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This study aimed to assess the different needs of patients with breast cancer and their families in online health communities at different treatment phases using a Latent Dirichlet Allocation (LDA) model. METHODS Using Python, breast cancer-related posts were collected from two online health communities: patient-to-patient and patient-to-doctor. After data cleaning, eligible posts were categorized based on the treatment phase. Subsequently, an LDA model identifying the distinct need-related topics for each phase of treatment, including data preprocessing and LDA topic modeling, was established. Additionally, the demographic and interactive features of the posts were manually analyzed. RESULTS We collected 84,043 posts, of which 9504 posts were included after data cleaning. Early diagnosis and rehabilitation treatment phases had the highest and lowest number of posts, respectively. LDA identified 11 topics: three in the initial diagnosis phase and two in each of the remaining treatment phases. The topics included disease outcomes, diagnosis analysis, treatment information, and emotional support in the initial diagnosis phase; surgical options and outcomes, postoperative care, and treatment planning in the perioperative treatment phase; treatment options and costs, side effects management, and disease prognosis assessment in the non-operative treatment phase; diagnosis and treatment options, disease prognosis, and emotional support in the relapse and metastasis treatment phase; and follow-up and recurrence concerns, physical symptoms, and lifestyle adjustments in the rehabilitation treatment phase. CONCLUSION The needs of patients with breast cancer and their families differ across various phases of cancer therapy. Therefore, specific information or emotional assistance should be tailored to each phase of treatment based on the unique needs of patients and their families.
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Affiliation(s)
- Chaojin Da
- Department of Nursing, School of Clinical Nursing, Gansu Health Vocational College, Lanzhou, China
| | - Yiwen Duan
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China
| | - Zhenying Ji
- Department of Nursing, School of Clinical Nursing, Gansu Health Vocational College, Lanzhou, China
| | - Jialin Chen
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China
| | - Haozhi Xia
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China
| | - Yajuan Weng
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China
| | - Tingting Zhou
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China
| | - Changrong Yuan
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China.
| | - Tingting Cai
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China.
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Lu SJ, Ku SC, Liu KF, Chien CH. Decision Self-Efficacy and Decisional Conflict on Reintubation among Surrogates of Ventilated Patients Undergoing Planned Extubation. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:235-244. [PMID: 37838098 DOI: 10.1016/j.anr.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
PURPOSE Although the medical decision-making process can be overwhelming for some surrogates, there is a lack of understanding regarding their experiences. The objectives of this study were to examine the decision self-efficacy and decisional conflict experienced by surrogates in intensive care units (ICUs) when faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation. In addition, predictors and mediators influencing these decision-making processes were identified. METHODS This study utilized a cross-sectional design to investigate the decision-making processes of 174 surrogates who were faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation in the internal ICU of a medical center between August 2021 and February 2022. Structured questionnaires were administered to collect data on the surrogates' background information, decision self-efficacy, decisional conflict, and positive and negative affect. The patients' background information was also collected. Univariate and multivariate analyses were performed to model the data. RESULTS The mean decision self-efficacy score of the surrogates was 82.41 points, and 20.7% surrogates had decisional conflict scores exceeding 37.5 points, suggesting that they faced challenges in the decision-making process. Surrogates' employment status and negative affect significantly predicted their decision self-efficacy. In addition, patients' activities of daily living prior to hospitalization and the decision self-efficacy of the surrogate significantly predicted surrogate decisional conflict. The impact of surrogates' negative affect on decisional conflict was fully mediated by decision self-efficacy. CONCLUSIONS Surrogate decision self-efficacy mediates the relationship between negative affect and decisional conflict. Providing clinical care interventions that focus on enhancing surrogate self-efficacy and reducing negative affect can help alleviate decisional conflict in this population.
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Affiliation(s)
- Shu-Ju Lu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuei-Fen Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ching-Hui Chien
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Chen J, Zeng L, Liu X, Wu Q, Jiang J, Shi Y. Family surrogate decision-makers' perspectives in decision-making of patients with disorders of consciousness. Neuropsychol Rehabil 2023; 33:1582-1597. [PMID: 36039997 DOI: 10.1080/09602011.2022.2116058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
To explore and describe the experience of decision-making for patients with disorders of consciousness (DOC) from the perspectives of family surrogate decision-makers. A total of 21 face-to-face interviews with family surrogate decision-makers from a tertiary hospital in Shanghai, China were conducted from January 2021 to February 2021. Thematic analysis was used for data analysis. Four main themes were identified and were included in this study: (1) a tough choice between life and dignity, (2) a major responsibility for patient's voice, (3) complex considerations between ethics and morals, and (4) the importance of realistic basis. The surrogate decision-making of DOC patients in China has been affected by the Chinese cultural context and several practical roots. And the family surrogate decision-makers shared their experiences of trade-offs during the decision-making process. Moreover, family surrogate decision-makers realized their serious responsibility to make a decision that would be in the best interest of DOC patients.
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Affiliation(s)
- Jiali Chen
- School of Medicine, Tongji University, Shanghai, People's Republic of China
- Delivery Room, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Li Zeng
- School of Medicine, Tongji University, Shanghai, People's Republic of China
- Department of Nursing, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Xianliang Liu
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, China
| | - Qian Wu
- Department of General Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Jinxia Jiang
- School of Medicine, Tongji University, Shanghai, People's Republic of China
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Yan Shi
- School of Medicine, Tongji University, Shanghai, People's Republic of China
- Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
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Wu YL, Yang CY, Lin TW, Shen PH, Tsai ZD, Liu CN, Hsu CC, Wang SSC, Huang SJ. Factors Impacting Advance Decision Making and Health Care Agent Appointment among Taiwanese Urban Residents after the Passage of Patient Right to Autonomy Act. Healthcare (Basel) 2023; 11:healthcare11101478. [PMID: 37239764 DOI: 10.3390/healthcare11101478] [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: 04/12/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
In recent years, advance care planning (ACP) promotion in Taiwan has expanded beyond clinical practice to the broader population. This study aims to investigate people's attitudes toward ACP and to identify factors influencing their signing of advance directives (ADs) and appointment of health care agents (HCAs). METHODS We identified 2337 ACP participants from consultation records between 2019 and 2020. The relationships among the participants' characteristics, AD completion, and HCA appointment were investigated. RESULTS Of 2337 cases, 94.1% completed ADs and 87.8% were appointed HCAs. Welfare entitlement (OR = 0.47, p < 0.001), the place ACP progressed (OR = 0.08, p < 0.001), the participation of second-degree relatives (OR = 2.50, p < 0.001), and the intention of not being a family burden (OR = 1.65, p = 0.010) were significantly correlated with AD completion. The probability of appointing HCAs was higher in participants with family caregiving experience (OR = 1.42, p < 0.05), who were single (OR = 1.49, p < 0.05), and who expected a good death with dignity (OR = 1.65, p < 0.01). CONCLUSIONS Our research shows that adopting ACP discussion in Taiwan is feasible, which encourages ACP conversation and facilitates AD completion. IMPLICATIONS Male and younger adults may need extra encouragement to discuss ACP matters with their families. LIMITATIONS due to sampling restrictions, our data were chosen from an urban district to ensure the integrity of the results. Furthermore, interview data could be collected in future research to supplement the quantitative results.
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Affiliation(s)
- Yi-Ling Wu
- Taipei City Hospital, Taipei 103212, Taiwan
| | - Chun-Yi Yang
- Taipei City Hospital, Taipei 103212, Taiwan
- Department of Health and Welfare, Tian-Mu Campus, College of City Management, University of Taipei, Taipei 111036, Taiwan
| | - Tsai-Wen Lin
- National Academy of Education Research, Taipei 237201, Taiwan
| | | | | | | | | | - Samuel Shih-Chih Wang
- Department of Health and Welfare, Tian-Mu Campus, College of City Management, University of Taipei, Taipei 111036, Taiwan
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Sui W, Gong X, Qiao X, Zhang L, Cheng J, Dong J, Zhuang Y. Family members' perceptions of surrogate decision-making in the intensive care unit: A systematic review. Int J Nurs Stud 2023; 137:104391. [PMID: 36442321 DOI: 10.1016/j.ijnurstu.2022.104391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND A better understanding of the perceptions of family members in making surrogate decisions for loved ones during intensive care is needed to inform the development of targeted supportive interventions. OBJECTIVE To examine and synthesize qualitative data on family members' perceptions of surrogate decision-making in the intensive care unit. DESIGN We conducted a systematic review and qualitative data synthesis. Eligible studies contained family members' quotes about surrogate decision-making experiences and perceptions in adult intensive care units, published in English or Chinese, in a peer-reviewed journal up to February 2022. Data sources included Embase, PubMed, ISI Web of Science, PsychINFO, CINAHL, Biomedical Literature Service System, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Journal. METHODS The searches yielded 5974 identified articles, of which 23 studies were included. At least two different reviewers independently assessed the study quality and extracted data into a Microsoft Excel spreadsheet. A thematic synthesis was performed by classifying all text units into one of the broad themes and subsequently analyzed to inductively develop the first-, second-, and third-order themes. Six family members with experience in intensive care unit surrogate decision-making contributed to the analysis. RESULTS The qualitative data synthesis resulted in five major themes. The following key new insights into family members' perceptions of surrogate decision-making in the intensive care unit were obtained: in individual systems, family members suffered from emotional distress and psychological stress; different cognitive styles emerged; some family members reshaped a new order of life in the disruption; in family systems, the family as a whole was closely connected with each other; and in medical systems families perceived asymmetry in relationships with clinicians, many factors influencing trust, the necessity for role-specific mediators and issues with operations and environments not being sufficiently humanized. CONCLUSION This qualitative synthesis showed that individuals' emotions and cognition underwent complex processes during surrogate decision-making. The family as a whole, with disparate functional states, also faced different processes and outcomes under the crisis situation. At a broader level, the decision-making process reflected society's perceptions of the medical system. Future studies should use these insights to further explore and optimize the many aspects of surrogate decision support measures for families of critically ill patients and include the measurement of outcomes after interventions at multiple layers of the individual, family, and medical systems. REGISTRATION NUMBER The protocol was prospectively published on International Prospective Register of Systematic Reviews (PROSPERO)-CRD42022316687. TWEETABLE ABSTRACT Families of critically ill patients undergo a complex interactional process within the individual, family, and medical systems during surrogate decision-making.
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Affiliation(s)
- Weijing Sui
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
| | - Xiaoyan Gong
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
| | - Xiaoting Qiao
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Lixin Zhang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Junning Cheng
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Jing Dong
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Yiyu Zhuang
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
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Kindie Abate H, Birhanu Yohanes Y, Hailu Gebrie M. Clinical decision making approaches and associated factors among nurses working in a tertiary teaching hospital. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zheng M, Yin C, Cao Y, Zhang Y, Zhang K, Zhang X, Bian W, Wang L. Development and evaluation of a decision aid for family surrogate decision-makers for patients with acute kidney injury requiring renal replacement therapy (RRT) in ICUs: a study protocol. BMJ Open 2021; 11:e043385. [PMID: 33579767 PMCID: PMC7883861 DOI: 10.1136/bmjopen-2020-043385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Shared decision making is endorsed by guidelines for both acute kidney injury and critical care medicine. However, there is still a huge need for effective interventions, especially those focusing on decisions about renal replacement therapy for intensive care unit (ICU) patients with acute kidney injury. The decision aids provide evidence-based support for shared decision making, to achieve better decisions through enhanced knowledge of treatment options and treatment aligns with patients' preferences and values. Therefore, our objectives are to develop and evaluate a decision aid systematically and rigorously for family surrogate decision makers of ICU patients with acute kidney injury who need renal replacement therapy. METHODS AND ANALYSIS We will use a systematic development process that focuses on user-centred design to develop and evaluate the decision aid in three phases: (1) development of a draft prototype for the decision aid based on extensive literature reviews, interviews with key stakeholders and evidence synthesis; (2) alpha testing ('near live' usability) the decision aid during simulated clinical encounters to test its comprehensibility, acceptability and usability and (3) beta testing ('live' usability) to examine the aid's clinical feasibility. User testing will be conducted using mixed-methods approach to support iterative revision of the decision aid. The IPDASi (V.4.0) will be used for following qualitative assessment. All interviews will be analysed by Colaizzi's seven-step approach to qualitative analysis. The coding scheme will use to analyse user interactions. Questionnaire surveys will be analysed using paired sample t-tests when related to the before-and-after survey, otherwise using one-sample t-test. ETHICS AND DISSEMINATION Ethical approval for this research was obtained from the Ethics Committee of the First Affiliated Hospital of Army Medical University, PLA (Ref: KY2020104). All participants will sign a formal informed consent form. The findings will be published in peer-reviewed journals and reported in appropriate meetings. TRIAL REGISTRATION NUMBER ChiCTR2000031613.
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Affiliation(s)
- Miao Zheng
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Changlin Yin
- Department of Critical Care Medicine, Southwest Hospital of Third Military Medical University (Amy Medical University), Chongqing, China
| | - Ying Cao
- Department of Critical Care Medicine, Southwest Hospital of Third Military Medical University (Amy Medical University), Chongqing, China
| | - Yonghui Zhang
- Department of Critical Care Medicine, Southwest Hospital of Third Military Medical University (Amy Medical University), Chongqing, China
| | - Kuoliang Zhang
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
- Academic Research Office, Qiannan Medical College for Nationalities, Duyun City, Guizhou Province, China
| | - Xiaoqin Zhang
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Wei Bian
- Department of Ophthalmology, Southwest Hospital of Third Military Medical University (Amy Medical University), Chongqing, China
| | - Lihua Wang
- Addmin Office, Southwest Hospital of Third Military Medical University (Amy Medical University), Chongqing, China
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Overview of the Motivation of Advance Care Planning: A Study from a Medical Center in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020417. [PMID: 33430302 PMCID: PMC7825806 DOI: 10.3390/ijerph18020417] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/25/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023]
Abstract
(1) Background: Since Taiwan's Patient Right to Autonomy Act took effect in 2019, up to ten thousand declarants have participated in advance care planning (ACP) and have signed advance directives (ADs). Relative to the entire population of Taiwan, only a small percentage have completed ACP. This study sought to understand the motivations of Taiwanese who have participated in ACP, so as to increase the percentage of individuals participating in ACP and signing ADs; (2) Objectives: To understand the motivations that drive Taiwanese individuals to participate in ACP discussions.; (3) Methods: A retrospective secondary data analysis was performed in this study. The participants consisted of declarants who completed their ACP at a medical center in Taiwan in 2019; (4) Results: During the study period, 946 individuals completed their ACP. Of those declarants, 66.7% were over 60 years of age; 66.5% completed the process in groups of three or more; 49.5% completed their ACP free of charge; and 35 declarants had designated a health care agent (HCA). The declarants' four main motivations for participating in ACP were "looking forward to dying with dignity," "making end-of-life preparations," "fear of being a social and economic burden on family members," and "reluctance to let family members take on the responsibility of making decisions." Furthermore, statistically significant differences were observed between the declarants in terms of gender, age, designation of an HCA, and motivations for participating in ACP. Females, declarants aged below 60 years, and declarants with a designated HCA tended to participate in ACP due to "reluctance to let family members to take on the responsibility of making decisions". Males, declarants aged above 60 years, and declarants without an HCA came for ACP because of "fear of being a social and economic burden on family members". (5) Conclusions: The main motivations of Taiwanese individuals who sought ACP were to die with dignity and to have an early understanding of end-of-life treatment and care models. Secondly, these individuals hoped that their families would not have to take on the responsibility of making decisions. They also did not want to impact their families socially and economically. In this regard, providing economic subsidies might enhance the Taiwanese public's intentions to seek ACP discussions on their own initiative.
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