The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community‐dwelling elderly participants. This cross‐sectional study enrolled 990 community‐dwelling elderly participants in three residential areas, with a mean age of 71.53 ± 7.22 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer‐administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β = 0.73, p <0.001), attitude (β = 0.06, p = 0.038) and decision (β = 0.14, p < 0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β = 0.57) than hospice knowledge (β = 0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β = 0.59) than hospice knowledge (β = 0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended.

Background:The annual medical litigation rate has increased yearly since 1987 in Taiwan. Policy makers keep going medical legislation reforms. The effectiveness of legislation reforms to reduce malpractice litigation risk is uncertain. Objective: To determine whether medical legislation reform helps reduce the risk of medical litigation. Design, Setting, and Participants: This retrospective study used national data obtained from Ministry of Health and Welfare in Taiwan. The period analyzed was from 1987 to 2018. The annual medical litigation rate was determined, types of medical negligence litigation were compared, medical appraisal results were summarized, and the importance of medical legislation was identified. Interventions: After legislation reform vs before legislation reform. Measurements: The main outcome showed trends in medical dispute assessments over time by adjusting for the general population (per 1, 000, 000 people). We established 2004 and 2012 as the 2 cut-points for further analysis of medical appraisal results due to legislation reform. Results: With legislation reforms, the annual medical litigation rate decreased from 26.68 cases per million people in 2012 to 16.41 cases per million people in 2018. The annual medical litigation rate declined by approximately 38% from 2012 to 2018. Medical appraisal results were malpractice cases in 22.1% before Medical Care Act (2004 Reform) compared with 18.8% from 2004 to 2012 (odds ratio [OR], 0.82; 95% CI, 0.727-0.924; p=0.001), and 6.4% after mediation system introduced in 2012 (odds ratio [OR], 0.243; 95% CI, 0.205-0.288; p<0.001). Conclusion: Medical legislation reform has reduced the risk of malpractice litigation over time.

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