Gender differences in the intention to withhold life-sustaining treatments involving severe dementia for self and on behalf of parent or spouse

Abstract

Background Few studies have explored gender differences in the attitudes toward advanced care planning and the intention to withhold life-sustaining treatments (LSTs) involving severe dementia in Asian countries. We examined gender differences in the attitude toward the Patient Autonomy Act (PAA) in Taiwan and how the gender differences in these attitudes affect the intention to withhold LSTs for severe dementia. We also investigated self–other differences in the intention to withhold LSTs between genders. Methods Between March and October 2019, a structured questionnaire was distributed to hospitalized patients’ family members through face-to-face contact in an academic medical center. Exploratory factor analysis and independent and paired-sample t-tests were used to describe gender differences. Mediation analyses controlled for age, marital status, and education level were conducted to examine whether the attitude toward the PAA mediates the gender effect on the intention to withhold LSTs for severe dementia. Results Eighty respondents filled out the questionnaire. Exploratory factor analysis of the attitude toward the PAA revealed three key domains: regarding the PAA as (1) promoting a sense of abandonment, (2) supporting patient autonomy, and (3) contributing to the collective good. Relative to the men, the women had lower average scores for promoting a sense of abandonment (7.48 vs. 8.94, p = 0.030), higher scores for supporting patient autonomy (8.74 vs. 7.94, p = 0.006), and higher scores for contributing to the collective good (8.64 vs. 7.47, p = 0.001). Compared with the women, the men were less likely to withhold LSTs for severe dementia (15.84 vs. 18.88, p = 0.01). Mediation analysis revealed that the attitude toward the PAA fully mediated the gender differences in the intention to withhold LSTs for severe dementia. Both men and women were more likely to withhold LSTs for themselves than for their parents. Compared with the women, the men were more likely to withhold resuscitation for themselves than for their parents (p = 0.05). Women were more likely to agree to enteral tube feeding and a tracheotomy for their husbands than for themselves; men made consistent decisions for themselves and their wives in those LST scenarios. Conclusion Gender influences the attitude toward advanced care planning and consequently affects the intention to withhold LSTs, indicating that there may be a difference in how men and women perceive EOL decision-making for severe dementia in Taiwan. Further studies are warranted.

Associations of health literacy, personality traits, and pro-individualism with the willingness to complete advance directives in Taiwan

“…Until the end of 2021, less than 0.2% of the adult population (35,545 of approximately 19.39 million adults) had completed an AD in Taiwan [11]. Low completion rates of ADs despite favorable attitudes toward ADs suggest that individual differences beyond access to information may influence the decision not to complete an AD [12].…”

“…Health literacy is critical in understanding, completing, and using advance directives. Low health literacy is associated with insufficient advanced care planning knowledge [ 12 ]. It can significantly impact an individual’s ability to make informed decisions regarding EOL care [ 27 ].…”

“…Therefore, we hypothesized mastery-persistence personality traits would be associated with willingness to complete ADs. In addition, given that people in Asia culture tend to be family-centered, people with a mindset similar to conscientiousness are likely to make decisions about their future health care beforehand to avoid burdening their family [ 12 ], which may be conducive to ACP engagement [ 44 ].…”