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

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.

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

“…Domestic studies also indicated that older adults were not evasive about dying [ [53] , [54] , [55] ]. However, domestic studies also showed the necessity of death education [ 29 , [56] , [57] , [58] , [59] ]. Participants in this study were purposefully selected.…”

“…In addition, The study indicated that relatively few aged citizens completed the forms due to lacing Internet technology abilities as the ‘Five Wishes’ forms were online and digital [ 24 ]. Furthermore, Chinese scholars conducted cross-sectional studies on the recognition, acceptance, knowledge, attitude and practice (KAP) of ADs using self-designed questionnaires among terminally ill patients, older adults and health professionals [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. Overall, the recognition, acceptance, knowledge and KAP of ADs among the population improved over time [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ].…”

“…Furthermore, Chinese scholars conducted cross-sectional studies on the recognition, acceptance, knowledge, attitude and practice (KAP) of ADs using self-designed questionnaires among terminally ill patients, older adults and health professionals [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. Overall, the recognition, acceptance, knowledge and KAP of ADs among the population improved over time [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. And health care professionals had a higher recognition and acceptance of ADs, better KAP of ADs compared with the other groups at the same time period [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ].…”

“…Overall, the recognition, acceptance, knowledge and KAP of ADs among the population improved over time [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. And health care professionals had a higher recognition and acceptance of ADs, better KAP of ADs compared with the other groups at the same time period [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. Furthermore, the localization and legislation process of ADs in the mainland of China has been difficult, complicated and tortuous.…”

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

“…15 In terms of the variable of physical health, the results from a cross-sectional study reported that patients with high comorbid conditions were more likely to complete an advance directive among 456 older nursing home residents. 16 Zhu et al 15 conducted a mixed-method study among 523 community older adults and the results showed that poor health condition was more preference toward advance care planning. Moreover, Gallagher et al 12 found that people with experience working in health or social care are likely to have increased advance care planning engagement.…”