Insisting on Life Dignity: Advance Care Planning in Taiwan During COVID-19 Pandemic

Abstract

Background:The coronavirus disease 2019 (COVID-19) outbreak is a global public health crisis that has affected the implementation of advance care planning (ACP) in Taiwan. The purpose of this study is to (1) confirm that COVID-19 significantly reduced public participation in ACP, (2) identify factors influencing the implementation of ACP during the COVID-19 pandemic and how they differ from those before the COVID-19 outbreak.Methods: An observational study from retrospective review of medical chart and clinical information.This is a hospital-based study to examine the characteristics of ACP implementation in Taiwan during COVID-19. A total of 1,253 participants were recruited, including 916 people who had completed ACP from September through December 2019, and 337 people from January through April 2020.Results:This study representing an approximately 65% decrease in ACP participation after COVID-19 outbreak. The cancellation rate of ACP during COVID-19 is higher before outbreak. After COVID-19 outbreak, Participation rate of disadvantaged populations increased from 16.92% to 21.66%. The percentage of participants with caregiver experiences decreased from 31.66%to to 23.44% . Participants who did not wish for their families to bear decision-making responsibilities increased from 44.00% to 52.52%. The percentage of offspring participation increased from 86.57% to 90.80%. The percentage of individuals completing ACP after the outbreak without signing an advance directive increased from 5.57% to 9.20%. The COVID-19 pandemic significantly reduced participation in ACP. Conclusions: This study directly compared the ACP implementation before and after COVID-19, which is a tremendous global health crisis influencing the conceptions of life and death.COVID-19 has threatened the public’s health and has changed ACP in the healthcare system by increasing public awareness of the topic of death. After COVID-19, both medical staff and the public should clearly express their opinions on terminal care.Policy supports and active participation of medical team can encourage disadvantages to complete ACP.Healthcare workers should provide palliative and terminal care services in which patient comfort and dignity are the primary focus of care.Trial registration:This study was approved on 3 June 2020 by the Taipei City Hospital Institutional Review Board (Case No.: TCHIRB-10808008-E).

Aspidistra daibuensis var. longkiauensis, a new variety of Aspidistra (Asparagaceae) from Taiwan, identified through morphological and genetic analyses

“… attenuata exhibits clear morphological differentiation. Several authors have recognized all these characters to differentiate species ( Hayata 1912 ; Liu and Ying 1978 ; Yang et al 2001 ; Wang 2004 ; Chao 2016 ; Lu et al 2020 ). A.…”

“… attenuata (Hayata) Ying. Subsequently, Yang et al (2001) demonstrated that the previously described three species differed from A. elatior , and that A.…”