Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

Abstract

Background The proportion of hospital deaths has declined in the past few decades, while the proportions of nursing home deaths have increased. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs. Under these circumstances, a comprehensive understanding of end-of-life care preferences in local nursing home residents can help healthcare professionals and policymakers develop strategies to increase the advance directive completion rate and quality of care. This study aimed to explore and compare advance directive and end-of-life care preferences of nursing home residents in Hong Kong and Taiwan. Methods A structured questionnaire was developed by the research team to investigate advance directive and end-of-life care preferences in older Chinese nursing home residents. Nursing home residents with frail or pre-frail status and over the age of 64 were invited to participate in the study, and information on demographics, functional status, advance directive experiences, and end-of-life care expectations was collected through questionnaire interviews. Results A total of 325 eligible participants from 32 facilities completed the survey, including 238 older residents in Hong Kong and 87 in Taiwan. A significantly lower proportion of the Hong Kong residents had completed an advance directive compared with the Taiwanese (3 vs. 13%, p = 0.001). Among participants who did not have an advance directive, 46% of the Taiwanese participants said they would consider completing one in the future, compared with 20% of the Hong Kong participants (p < 0.001). A total of 79% of the Hong Kong participants and 80% of the Taiwanese participants responded that prolonging life in the given hypothetical dying scenario was “not important” (p = 0.76). Only 14% of participants in Hong Kong and 18% of participants in Taiwan reported prior occurrence of end-of-life care discussions with family members or health professionals (p = 0.37). Conclusions This paper adds evidence in support of improving end-of-life communication and the advance directive completion rate in nursing homes in Hong Kong and Taiwan. Further research is necessary to explore cross-cultural differences in end-of-life preferences and its applications in predicting decision-making and the quality of end-of-life care.

The decisional balance, attitudes, and practice behaviors, its predicting factors, and related experiences of advance care planning in Taiwanese patients with advanced cancer

“…This suggested that most of our study participants rarely inquired about ACP and that few healthcare professionals provided relevant information. This finding was consistent with prior studies [9][10][11] which documented that patients with terminal diseases or longterm care residnets were willing to discuss ACP but, in fact, their medical providers rarely discussed this topic with their patients. This might due to the fact that medical personnel were reticent to broach this topic reflecting their concern that early implementation of ACP could engender fear in patients or communicate a sense of hopelessness regarding their prognosis [36].…”

“…This percentage was 33.3% in the US [ 8 ], but only 16.1% in Taiwan [ 9 ]. Similarly, studies conducted in Hong Kong found that less than 20% of nursing home residents ( n = 238) ever discussed ACP issues with their family members or healthcare professional [ 10 ] and for seriously ill patients and their caregivers still perceived limited autonomy in ACP decision-making and lack of readiness and awareness of discussion of ACP [ 11 ]. Further, a meta-analysis of 38 studies [ 12 ] found that an average of 33–38% of EOL patients actually received non-beneficial treatment (NBT) during their last 6 months of life.…”

Factors Associated with Advance Directives Documentation: A Nationwide Cross-Sectional Survey of Older Adults in Korea

“…Social relationships may broaden opportunities for sharing information about ADs and communicating perspectives and preferences about EOL care, which can lead to further discussions and documentation of ACP [ 22 , 24 ]. Although older adults mainly discuss EOL with family members [ 25 , 45 ], in reality, only a few do so because they do not want to burden their family members [ 46 , 47 ]. Furthermore, the number of older Asians living without children or living in single-person households has rapidly increased [ 48 ].…”

Factors Influencing Older Adults' End-of-Life Care Preferences

“…15 In addition, 79% to 80% of Hong Kong and Taiwanese older adults were reluctant to prolong life in the study scenarios. 15 However, there are little data on the impact of EOL care preferences for older adults in Asia. This article analyzes factors in Taiwan influencing older adults' EOL care preferences and expects to provide evidence in caring for older adults in EOL care.…”