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Wang X, Wu Y, Bai X, Qiao Q, Yu L, Ge L, Qi L, Zang S. Acceptance level of advance care planning and its associated factors among the public: A nationwide survey. BMC Palliat Care 2024; 23:201. [PMID: 39107758 PMCID: PMC11301855 DOI: 10.1186/s12904-024-01533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model. METHODS A total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP. RESULTS On a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00-83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP. CONCLUSIONS This study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges.
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Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China
| | - Yibo Wu
- School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xinghua Bai
- Department of Radiation Oncology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Qiao Qiao
- Department of Radiation Oncology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Ling Yu
- Phase I Clinical Trails Center, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Lina Ge
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping Area, Shenyang, 110004, Liaoning Province, China
| | - Li Qi
- School of Nursing, Qiqihar Medical University, No.333, Bukui North Street, Jianhua District, Qiqihar City, 161006, Heilongjiang Province, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China.
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Chan KP, Chung WK, Hsu DY, Kong SY, Tin W, Chan CH, Hwang E, Chan OM, Chui R, Cheng HWB. "What you Say Matters": Review of Clinical Outcome of Advanced Medical Directives Between Cancer and Non-cancer Patients in a Chinese Culture Society. Am J Hosp Palliat Care 2024:10499091241268304. [PMID: 39056381 DOI: 10.1177/10499091241268304] [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: 07/28/2024] Open
Abstract
INTRODUCTION Advance medical directives (AMD) are statements made by individuals indicating the life-sustaining treatment that they would refuse in the future when they lost their mental capacity for medical decisions. While the proposal for the AMD legislation is ongoing locally in Hong Kong SAR, there are limited reviews on the clinical outcomes associated with it. OBJECTIVE To provide a comprehensive review on clinical outcomes of signed AMD. METHODOLOGY Retrospective, multi-center study, which includes AMD signed within five cluster hospitals. Records of signed AMD from 1st JAN 2020 to 31st DEC 2022 were retrieved from a central registry. Clinical information of each patient was obtained from the electronic patient record. RESULT 456 patients with documented AMD were included in the study. 91.6% of AMD were signed by palliative care (PC) team. Majority (74.6%) of the patients were accompanied by family members or friends when AMD were signed. The concordance rate between the AMD and the medical care received was 89.5%. No patient revoked their AMD. Cancer and non-cancer patients showed similar rates of AMD concordance, frequency of Accident & Emergency Department (AED) visits or acute ward admissions, duration of hospital stays in the 30 days before death, and prevalence of receiving invasive or intensive treatments. CONCLUSION Our study demonstrated that PC team currently plays a pivotal role in AMD completion, and AMD remains important in ensuring patients' care preferences are executed across different medical conditions. With the upcoming AMD legislation in Hong Kong SAR, adequate promotion and education should be launched.
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Affiliation(s)
- Ka Po Chan
- Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong SAR
| | - Wai Kei Chung
- Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong SAR
| | - Dany Young Hsu
- Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong SAR
| | - Shun Yin Kong
- Department of Medicine and Geriatrics, Pok Oi Hospital, Tin Shui Wai Hospital, New Territories, Hong Kong SAR
| | - Winnie Tin
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories, Hong Kong SAR
| | | | | | - Oi Man Chan
- Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong SAR
| | - Ruby Chui
- Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong SAR
| | - Hon Wai Benjamin Cheng
- Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong SAR
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Che SL, Leong SM, Lau WS, Tam KI. Reliability and Validation Study of Advance Care Planning Practice Scale among Health and Social Care Professionals. Healthcare (Basel) 2024; 12:200. [PMID: 38255087 PMCID: PMC10815370 DOI: 10.3390/healthcare12020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Advance care planning (ACP) is a crucial process in clinical practice, enabling individuals to articulate their care preferences and goals, with significant implications for future healthcare. However, ACP practice of health and social care professionals (HSCPs) concerning patients, or their family members are rarely explored. The objective of the study was to adapt and validate a four-item scale assessing ACP practices of HSCPs toward patients or their family members. The ACP Practice Scale was evaluated through a cross-sectional online survey administered to HSCPs in Macao, assessing its factor structure, validity, and reliability. Based on a sample of 186 valid responses, the ACP Practice Scale demonstrated satisfactory levels of validity and reliability among HSPCs in Macao. The four-item scale explained 65.87% of the variance in ACP practice and exhibited strong internal consistency, with Cronbach's alpha and McDonald's omega coefficients of 0.82. Furthermore, item factor loadings ranged from 0.71 to 0.90. The ACP Practice Scale provides reliable and valid measurements of ACP practice among HSCPs. This instrument can help to enhance our understanding of ACP practices in clinical settings and support the advancement of advance care planning.
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Affiliation(s)
- Sok-Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China;
| | - Sok-Man Leong
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China;
| | - Wing-Sze Lau
- Lar de Cuidados de Ká Hó da Federação das Associações dos Operários de Macau, Estr. de Nossa Sra. de Ka Ho, Macao SAR, China
| | - Kuai-In Tam
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China;
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Lim MK, Wong PS, Othman S, Mohd Mydin FH, Lim PS, Lai PSM. A Systematic Review of Non-Seriously Ill Community-Dwelling Asians' Views on Advance Care Planning. J Am Med Dir Assoc 2023; 24:1831-1842. [PMID: 37844872 DOI: 10.1016/j.jamda.2023.09.008] [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: 03/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To systematically synthesize the views of community-dwelling Asians on Advance care planning and to summarize the factors and reasons affecting their uptake of ACP. DESIGN Mixed-methods systematic review (PROSPERO: CRD42018091033). SETTING AND PARTICIPANTS Asian adults (≥18 years old) living in the community globally. METHODS Medline (Ovid), Web of Science, CINAHL (EBSCO), Open Grey, and Google Scholar were searched from inception to June 30, 2022. Qualitative, quantitative, or mixed-methods studies reporting on the views of non-seriously ill community-dwelling Asian adults on ACP or the factors influencing their ACP uptake were included. Secondary research, studies not published in English, or studies not available as full text were excluded. Two independent teams of researchers extracted data, assessed methodologic quality, and performed the data analysis. Data analysis was conducted using the multistep convergent integrated approach based on Joanna Briggs Institute methodology for mixed-methods systematic review. RESULTS Fifty-eight studies were included. Non-seriously ill community-dwelling Asians were willing to engage in ACP (46.5%-84.4%) although their awareness (3.1%-42.9%) and uptake of ACP remained low (14.0%-53.4%). Background factors (sociodemographic factors, and health status, as well as experience and exposure to information) and underlying beliefs (attitude toward ACP, subjective norm, and perceived behavioral control) were found to affect their uptake of ACP. A conceptual framework was developed to facilitate a proper approach to ACP for this population. CONCLUSIONS AND IMPLICATIONS A flexible approach toward ACP is needed for non-seriously ill community-dwelling Asians. There is also a need to raise end-of-life and ACP literacy, and to explore ways to narrow the gap in the expectations and implementation of ACP so that trust in its effective execution can be built.
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Affiliation(s)
- Mun Kit Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Pharmacy, Monash University, Selangor, Malaysia
| | - Pei Se Wong
- International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajaratulnisah Othman
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Fadzilah Hanum Mohd Mydin
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Pei Shan Lim
- Anaesthetic Department, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
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Li X, Che SL, Zhu M, Ng WI. What we learnt from parents' death experience: A cross-sectional study of death literacy and parent's death quality among adult children in China. Palliat Support Care 2023:1-9. [PMID: 38031427 DOI: 10.1017/s1478951523001657] [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: 12/01/2023]
Abstract
OBJECTIVES This study aims at investigating the current status of death literacy and parent's death quality among adult children in China. A cross-sectional survey was conducted to explore the associations between death literacy and parent's death quality and to provide evidence for developing public policies for improving the quality of death and end-of-life care for the population in the Greater Bay Area (GBA) of China. METHODS A cross-sectional design was adopted. Participants who experienced their father's and/or mother's death were recruited from 5 cities in the GBA of China in 2022. The Good Death Inventory (GDI) and the Death Literacy Index (DLI) were used to investigate the perceived quality of death of the parents of the participants and the death literacy of the participants. RESULTS A total of 511 participants were recruited. Participants with higher GDI scores were positively associated with DLI scores (p < 0.001). Adult children who had close relationships before their parents' death also had higher levels of DLI. SIGNIFICANCE OF RESULTS This study investigated death literacy among bereaved adult children in China, filling a gap in the investigation of death literacy among Chinese residents. It found that parents' death experience can have a significant impact on the death literacy of adult children, which may affect their understanding and preparation for their own eventual death. Promotion of family discussion on death, development of community palliative care, and improving public death literacy are urgently needed in China.
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Affiliation(s)
- Xiang Li
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
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Tumosa N. Using the Age-Friendly Health Systems Framework to Track Wellness and Health Promotion Priorities of Older Adults in the Global Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4617. [PMID: 36901627 PMCID: PMC10001799 DOI: 10.3390/ijerph20054617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
The promotion of health and wellness interventions for older adults is important in controlling the onset and progression of disabilities as well as disease in these individuals [...].
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Affiliation(s)
- Nina Tumosa
- Senior Public Health Advisor-Geriatrics, Division of Medicine and Dentistry, Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS), Rockville, MD 20857, USA
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Yang Y, Qu T, Yang J, Ma B, Leng A. Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610071. [PMID: 36011706 PMCID: PMC9408283 DOI: 10.3390/ijerph191610071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 05/27/2023]
Abstract
Shared decision-making (SDM) has been institutionally recognized as clinically effective by many Western healthcare systems. Nevertheless, it appears culturally unattractive in China, a country that adheres to Confucian familism which strongly prefers collective family decisions. This study examined this conflict and assessed the influence of Confucian familism on SDM in end-of-life (EOL) care for advanced cancer patients. Between August and November 2018, 188 EOL advanced-cancer patients were randomly recruited from 640 cancer hospital medical records at a Tertiary A-level hospital in Shandong province. Eventually, 164 (87.23%) sample patients were included in the statistical analysis after the non-responsive cases (4.79%) and missing value (7.98%) were removed. SDM was measured through SDM-Q-9, and the patient's siblings were used as indicators of Confucian Familism. Of the 164 patients, the mean SDM score was 38/100; 47.6% were thoroughly unfamiliar with their treatment plans and fell outside the decision-making procedure. Each patient had four siblings on average. Ceteris paribus, more siblings led to lower SDM. Moreover, being 56-65 years old and open-minded were associated with higher SDM, while higher satisfaction of the quality of EOL care yielded lower SDM. In conclusion, Confucian familism weakened patient-clinician SDM in EOL care for advanced cancer patients.
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Affiliation(s)
- Yuexi Yang
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| | | | - Jinyue Yang
- Qingdao Center for Women and Children’s Health and Family Planning Service, Qingdao 266034, China
| | - Ben Ma
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
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Kim B, Choi J, Lee I. Factors Associated with Advance Directives Documentation: A Nationwide Cross-Sectional Survey of Older Adults in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073771. [PMID: 35409452 PMCID: PMC8997513 DOI: 10.3390/ijerph19073771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022]
Abstract
Advance directives (ADs) can support autonomy in making healthcare decisions and minimize unnecessary discomfort during the treatment process at the end of life (EOL). This study aimed to investigate the factors that influence AD documentation among community-dwelling older adults. We used data from the National Survey of Older Koreans which was conducted nationwide in 2020. Data from participants aged 65 years or older were extracted using stratified multistage cluster sampling and the survey was conducted through one-on-one interviews. A total of 9920 older adults were included in this study: 421 respondents (4.7%) claimed that they had prepared for AD. Multivariable logistic regression analysis showed that being 75 years or older, having higher educational attainment, higher income, having any chronic disease(s), being screened for dementia in the past, being against futile life-sustaining treatment, taking a lecture on death and being registered for organ donation were positively associated with AD. Furthermore, when health was rated as average, it was associated with reduced odds of AD documentation compared when health was rated as good. These results suggest that more targeted efforts are required to promote EOL discussions among older adults.
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Affiliation(s)
- Boram Kim
- Division of Health Policy, Bureau of Health Policy, Ministry of Health and Welfare, Sejong-si 30113, Korea;
| | - Jiyeon Choi
- Division of Medical Law & Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Ilhak Lee
- Division of Medical Law & Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul 03722, Korea;
- The Asian Institute of Bioethics and Health Law, College of Medicine, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-2538
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Ni P, Wu B, Lin H, Mao J. Advance directives and end-of-life care preferences among adults in Wuhan, China: a cross-sectional study. BMC Public Health 2021; 21:2042. [PMID: 34749682 PMCID: PMC8574939 DOI: 10.1186/s12889-021-12046-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background Little is known about advance directives (ADs) and end-of-life (EOL) care preferences among the general population in Mainland China. This study aimed to describe knowledge and attitudes of ADs and EOL care preferences, and to explore factors related to preferences for ADs among Chinese adults. Methods The sample included 1114 adult participants in Wuhan, Mainland China. A brief message including the link to the online survey was sent to local residents who were registered at household registration management centers in Wuhan. The questionnaire included information regarding demographics, self-rated health, views on ADs and EOL care. Bivariate analyses and binary forward logistic regression were conducted to examine factors related to ADs preferences of Chinese adults. Results The average age of the sample was 48.0 years and more than half of the sample was female. 81.8% had never heard of ADs, but 86.6% indicated that they might create one after learning what ADs were. 58% would choose hospice care if they were terminally ill whereas 48.7% of the participants wanted to die at home. 92.3% would want to know their diagnosis and prognosis if ill; however, if their family members were diagnosed with an incurable disease, 50.5% would not tell their ill family member the actual diagnosis and prognosis. Those who had heard of ADs (OR = 1.567, p < 0.001), earned an associate’s degree (OR = 2.448, p < 0.001) or a bachelor’s degree or higher (OR = 2.382, p < 0.001), and self-rated their health as very poor/poor (OR = 1.002, p = 0.001) were more likely to be willing to make an AD than their counterparts. However, those who were single (OR = 0.149, p < 0.001) or widowed /divorced/separated (OR = 0.405, p = 0.001) were less likely to be willing to make an AD than the married ones. Conclusions Chinese adults showed positive attitudes towards ADs. There is an urgent need to promote more educational initiatives and raise awareness on the importance of ADs. It is important to develop more policies and legislation about ADs to improve the quality of EOL care in Mainland China.
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Affiliation(s)
- Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China.
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY, 10010, USA
| | - Huijing Lin
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China
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