Prevalence, Perception, and Predictors of Advance Directives among Hong Kong Chinese: A Population-Based Survey

Abstract

Advance directives (AD) can be used for the communication of healthcare decisions that may be required in the future when individuals have lost their capacity to make such decisions. The aim of this study is to examine the prevalence, perception, and predictors of AD completion in the Hong Kong general population with a diverse culture. Through random-digit dialing, a population-based telephone survey was conducted with participants aged 18 or above. Socio-demographic characteristics, self-perception and health status, prevalence of AD, and perceptions related to AD were assessed. The acceptance on completing AD was measured by the summed score on the level of agreement in making AD. In total, 2002 participants completed the survey, with only 0.5% having made AD. However, the majority of those who had heard about AD had made or intended to make AD (80.2%). Multivariable regression analysis showed that being religious, being optimistic, and agreeing to respect patients’ wishes are independently associated with higher AD acceptance. Being a student is associated with lower AD acceptance. The extremely low completion rate of AD, but high acceptance of AD urges for more active promotion of AD to the public and education on end-of-life care among university students.

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

“…It was anticipated that a higher proportion of Taiwanese participants would have an AD compared with Hong Kong participants, as the AD completion rate has been reported to be five times higher in the general population in Taiwan than in Hong Kong [ 10 , 12 ]. A total of 13% of Taiwanese nursing home residents in our study had an AD, which is comparable to the rates identified in the existing literature [ 18 , 19 ].…”

Prevalence and Predictors of Willingness to Make Advance Directives among Macao Chinese

“…Another study found that people who had considered what life-sustaining treatments entailed supported the legalization of ADs, and those who wanted to be informed about their own medical status were more likely to agree with writing ADs [11]. With respect to inhibitors, being female and students were found to have significantly reduced one's willingness to make ADs [12,13]. Furthermore, people with a low level of education were less likely to approve ADs [7].…”

“…To date, ADs are considered to be part of government's healthcare agenda, but there is a significant lack of information reflecting Macao residents' views on ADs. Existing studies found that some socio-demographic factors, medical status, and knowledge of life-sustaining treatments would influence people's willingness to make ADs [7,[10][11][12][13]. However, research on people's willingness to set up ADs is limited in Chinese communities.…”

The Role Complexities in Advance Care Planning for End-of-Life Care—Nursing Students’ Perception of the Nursing Profession

“…The research cited that a nurse's values and personal experience could possibly hinder or facilitate the implementation of ACP [33]. The results in the current study could possibly be explained by the significant association between student status and a lower degree of acceptance of AD in a local study, possibly because they are unprepared for life threats and advance directives [40].…”

“…For practical implications, the enhancement of EOL education, which was proven to be effective in changing students' attitudes, would enable nursing undergraduates to possess a more positive attitude toward the care of patients who are dying [40]. A significant association between academic year and positive attitude toward end-of-life care was revealed; final-year students were more open and positive toward caring for a dying patient.…”