Advance Directive and End-of-Life Care Preferences Among Chinese Nursing Home Residents in Hong Kong

Chu, Leung Wing; Luk, James Ka-Hay; Hui, Elsie; Chiu, PW; Chan, Cherry Sze Yan; Kwan, Fiona; Kwok, Timothy; Lee, Diana; Woo, Jean

doi:10.1016/j.jamda.2010.08.015

Cited by 80 publications

(95 citation statements)

References 38 publications

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“…They were willing to discuss ACP and their AD preferences. Contrary to the taboo belief and consistent with the studies of nursing home residents, 3,4 about 80% of elders preferred to have a say in decision making. In contrast, only 15.1% of family members felt comfortable to make a decision themselves without involving the elder.…”

supporting

confidence: 54%

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Who and when should we discuss advance care planning?

2018

Asian J Gerontol Geriatr

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supporting

confidence: 54%

“…However, studies of Hong Kong nursing home residents revealed that elders preferred to voice their wishes. 3,4 In general, nursing home residents are more disable and frail, and at a late stage of their life.…”

mentioning

confidence: 99%

Who and when should we discuss advance care planning?

2018

Asian J Gerontol Geriatr

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“…The proportion that rejected active treatment near the end of life was much lower than those reported in a Hong Kong Chinese nursing home study, which found that more than half of the residents did not want CPR and artificial nutrition to be started. 7 However, unlike our study, the Hong Kong study did not explore the residents' life-sustaining treatment experiences, 7 which may have contributed to these different results. In another study, 92% of Canadian caregivers who had provided end-of-life care to family indicated that they would in the future reject futile life-sustaining treatment to extend life, 29 suggesting that people with previous life-sustaining treatment experiences may be more likely to reject this level of intervention in the future, but this notion needs to be further explored.…”

Section: End-of-life Care Preferences Among Nursing Home Residentsmentioning

confidence: 66%

“…7 Another Hong Kong study identified that many nursing home residents were uncertain or uncomfortable when asked about stating their preferences for life-sustaining treatment, with many leaving this question unanswered. 6 In traditional Chinese culture, death is a very sensitive issue, and a topic to be avoided, with those who do mention death considered sacrilegious.…”

mentioning

confidence: 99%

Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

Zhou

Wang

et al. 2014

Journal of the American Medical Directors Association

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Objectives: To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-oflife care preferences and to explore the predictors of their preference for AD. Design: Population-based cross-sectional survey. Settings: Nursing homes (n ¼ 31) in Wuhan, Mainland Southern China. Participants: Cognitively intact nursing home residents (n ¼ 467) older than 60 years. Measures: Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences. Results: Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about lifesustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098). Conclusions: Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.With the aging of China's population, the demand for nursing home care is increasing.1 In Wuhan, a southern city in Hubei province, Mainland China, there are approximately 9.79 million people.

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“…Another option is for the patient to sign an AD, a formal tool that respects the autonomy of patients and in which any decision must be adhered to by the health care team. 28 In Hong Kong, life-sustaining treatment, including tube feeding, can be withheld if there is a valid AD when the patient is in an irreversible coma, persistent vegetative state, terminal illnesses, or other end-stage irreversible life-limiting condition. 29 Nonetheless until recently ACP and AD have been seldomly discussed in Hong Kong.…”

Section: Lack Of An Advance Directive and Advance Care Planningmentioning

confidence: 99%