The Attitudes of Chinese Cancer Patients and Family Caregivers toward Advance Directives

Abstract

Advance directives (ADs) have been legislated in many countries to protect patient autonomy regarding medical decisions at the end of life. China is facing a serious cancer burden and cancer patients’ quality at the end of life should be a concern. However, limited studies have been conducted locally to gather information about attitudes toward ADs. The purpose of this study was to investigate the attitudes of Chinese cancer patients and family caregivers toward ADs and to explore the predictors that are associated with attitudes. The study indicated that although there was low awareness of ADs, most cancer patients and family caregivers had positive attitudes toward ADs after related information was explained to them. Participants preferred to discuss ADs with medical staff when they were diagnosed with a life-threatening disease. Preferences for refusing life-sustaining treatment and choosing Hospice-Palliative Care (HPC) at the end of life would increase the likelihood of agreeing with ADs. This suggests that some effective interventions to help participants better understand end-of-life treatments are helpful in promoting ADs. Moreover, the development of HPC would contribute to Chinese cancer patients and family caregivers agreeing with ADs.

Advance directives of lung cancer patients and caregivers in China: A cross sectional survey

“…14% of the Australian population had ADs . After being informed about the concept of ADs, 79.7% of the patients and 75.2% of the caregivers were willing to have ADs, which was in line with previous studies conducted in various cancer patients . Interestingly, at the very beginning, our researchers were concerned about the cancer patients’ cooperation with the investigation.…”

“…Based on previous studies, we developed a structured questionnaire to explore the attitudes of patients and caregivers toward ADs. The content validity of the questionnaire was tested by a group of five experts in the field of end‐of‐life care and lung cancer.…”

“…In 2000, Taiwan was the first place in Asia to enact legislation to provide people with the right to make do‐not‐resuscitate (DNR) decisions . However, there is no legislation for ADs in mainland China . The overall AD preparation rate is low.…”

“…Since different diseases have different diagnosis and treatment procedures and mortality differs among them, it seems necessary to focus on a specific disease. Moreover, there has been a lack of comparison between patients and caregivers since some studies have analyzed these data together . Patients and caregivers may hold different attitudes toward ADs since healthy people may have no idea about the situation when they are ill.…”

Chinese version of the Cancer Support Person’s Unmet Needs Survey-Sort Form: A psychometric study

“…Cancer caregivers are defined as individuals (e.g., spouses, adult offspring, parents and friends) who devote a significant amount of time and energy to take care of their loved ones who have been diagnosed with cancer (Kent et al, ). In China, cancer caregivers provide various practical support to the patient, including day‐to‐day physical and psychological care, assisting with medical decision‐making, communication with healthcare staff, searching for information and solving financial issues (Cui, Song, Zhou, Meng, & Zhao, ; Gu, Chen, Liu, Zhang, & Cheng, ; Xie, Su, Liu, Wang, & Zhang, ; Yang et al, ; Zhang, Xie, Xie, & Liu, ). Consequently, cancer caregivers often experience a number of negative physical and psychological burdens, including reduced quality of life (QOL; Applebaum & Breitbart, ; Bevans & Sternberg, ; Lapid et al, ; Stenberg, Ruland, & Miaskowski, ; Yang et al, ), as a result of their caregiving duties.…”