Factors associated with advance directives completion among patients with advance care planning communication in Taipei, Taiwan

Chu, Dachen; Yen, Yung‐Feng; Hu, Hsiao Yun; Lai, Yun Ju; Sun, Wen Jung; Ko, Ming-Chung; Huang, Li; Chen, Chu Chieh; Curtis, J. Randall; Lee, Ya-Ling; Huang, Sheng Jean

doi:10.1371/journal.pone.0197552

Cited by 40 publications

(53 citation statements)

References 24 publications

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“…10 In addition, a Patient Right to Autonomy Act was passed in 2015 and came into force on 6 January 2019; already annually over a thousand patients have participated in an advance care planning communication program undertaken since 2015 in Taipei. 11…”

Section: Introductionmentioning

confidence: 99%

Patients’ preferences and factors influencing initial advance care planning discussions’ timing: A cross-cultural mixed-methods study

et al. 2020

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Background: Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain. Aim: To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan. Design: Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing. Setting/participants: Patients aged 40–75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited. Results: Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan ( p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers’ initiative. Conclusion: The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients’ preferences and factors associated with acceptance and reluctance to initiate advance care planning.

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Section: Introductionmentioning

confidence: 99%

Patients’ preferences and factors influencing initial advance care planning discussions’ timing: A cross-cultural mixed-methods study

et al. 2020

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“…Patient involvement ought to be higher in the societies where advance care planning and/or advance directive are mandatory in a certain situation (e.g. USA [20] and Taiwan [21,22]). Third, cultural perspectives and patients' (and family's) preferences that stem from them can be in uential.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Chu et al demonstrated that the implementation of palliative care training for healthcare providers and a program to routinely implement ACP for hospitalized patients with chronic life-limiting illness is feasible and successful in Taipei. [21] Providing physicians with appropriate educational opportunities and training, such as end-of-life care, psychological support for patients and their families, and communication skills training is essential.…”

Section: Discussionmentioning

confidence: 99%

Patient Participation and Associated Factors in the Discussions on Do-Not-Attempt-Resuscitation and End-of-Life Disclosure: A Retrospective Chart Review Study

Abe

Kobayashi

Kohno

et al. 2020

Preprint

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BackgroundPatient participation is a key foundation for advance care planning (ACP). However, a patient himself/herself may be left out from sensitive conversations such as end-of-life (EOL) care discussions. The objectives of this study were to investigate patients’ participation rate in the discussion of Cardiopulmonary Resuscitation (CPR) / Do-Not-Attempt-Resuscitation (DNAR) order, and in the discussion that the patient is at his/her EOL stage (EOL disclosure), and explore their associated factors.MethodsThis is a retrospective chart review study. The participants were all the patients who were hospitalized and died in a university-affiliated teaching hospital (tertiary medical facility) in central Tokyo, Japan during the period from April 2018 to March 2019. The following patients were excluded: (1) cardiopulmonary arrest on arrival (CPAOA); (2) stillbirth; (3) under 18 years old at the time of death; and (4) refusal by their bereaved family. Presence or absence of CPR/DNAR discussion and EOL disclosure, patients’ involvement in those discussions, and their related factors were investigated.ResultsCPR/DNAR discussion was observed in 336 out of the 359 patients (93.6%). The patient participation rate was 33.3% (n= 112). Male gender (odds ratio (OR) = 2.37 [95% confident interval (CI) 1.32-4.25]), living alone (OR = 2.51 [1.34 - 4.71]) and one year or more from diagnosis (OR = 1.78 [1.03 - 3.10]) were associated with patient’s participation in CPR/DNAR discussion. EOL disclosure was observed in 341 out of the 359 patients (95.0%). Half of the patients (n=171; 50.1%) participated in the discussion. Patients who died of cancer (OR = 2.41[1.45-4.03]) and patients without mental illness (OR=2.41 [1.11-5.25]) were more likely to participate in EOL disclosure.ConclusionsIn this clinical sample, only up to half of the patients participated in CPR/DNAR discussion and EoL disclosure. Further attempts to facilitate patients' participation, based on their preference, are warranted. A few sociodemographic, psychosocial, and medical factors that relate to patients’ participation in the discussion on CPR/DNAR and EOL disclosure were demonstrated.

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“…For example, Singapore passed the Advance Medical Directive Act in 1996 (Tee, Seet, Tan, & Choo, ) but in Hong Kong, advance directives are not yet supported with legislation (Chung et al, ). Taiwan was the first country in Southeast Asia to enact a Patient Self‐Determination Act in 2015 (Chu et al, ) similar to that which exists in the United‐States. This act is not specific to mental health but allows individuals with mental capacity to register an advance directive documenting their wishes for medical care (Chu et al, ).…”

Section: Legislationmentioning

confidence: 99%

“…Taiwan was the first country in Southeast Asia to enact a Patient Self‐Determination Act in 2015 (Chu et al, ) similar to that which exists in the United‐States. This act is not specific to mental health but allows individuals with mental capacity to register an advance directive documenting their wishes for medical care (Chu et al, ). Unsurprisingly, systematic reviews of the effectiveness of advance medical directives in Asia are lacking, possibly because the service user demand for such services has been low due to limited awareness (Chu et al, ; Gowda et al, ; Lai, Mohd Mudri, Chinna, & Othman, ; Tay, Chia, & Sng, ).…”

Section: Legislationmentioning

confidence: 99%

Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries

Poremski

Alexander

Fang

et al. 2019

Asia-Pacific Psychiatry

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People with mental illness may be unable to provide critical input about the care they wish to receive during a psychiatric crisis because of altered mental states. It is therefore imperative that clinicians seek to understand service users' wishes for care while they are well and able to provide meaningful input into the discussion. Achieving such an end may be done by discussing and completing a psychiatric advance directive. However, very few Asian countries have legislation that supports such advance directives. The present article seeks to give physicians more information about advance psychiatric directives and the potential role they could play to improve the healthcare provided in Asia to people at risk of losing capacity due to a mental illness.The degree to which mental health legislation supports psychiatric advance directives is documented for each country of South

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Factors associated with advance directives completion among patients with advance care planning communication in Taipei, Taiwan

Cited by 40 publications

References 24 publications

Patients’ preferences and factors influencing initial advance care planning discussions’ timing: A cross-cultural mixed-methods study

Patients’ preferences and factors influencing initial advance care planning discussions’ timing: A cross-cultural mixed-methods study

Patient Participation and Associated Factors in the Discussions on Do-Not-Attempt-Resuscitation and End-of-Life Disclosure: A Retrospective Chart Review Study

Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries

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