Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China

Abstract

Purpose Many cancer patients do not have advance directives (ADs), which may lead to unwanted excessive or aggressive care when patients have lost decision-making capacity. The aim of this study was to investigate knowledge and attitudes of approving ADs and explore factors associated with willing to designate ADs among cancer patients in China. Methods We conducted semi-structured interview method investigating 753 in-patients with cancer in two cancer centers. Results Of those subjects, none of the cancer patients had an AD. Only 22.4 % (118 of 526) approved ADs. Comparing with the disapproved ADs group, the approved ADs group were more likely to discuss the AD with oncologist or nurse (χ 2 = 180.4, p < 0.001) in the cancer center (χ 2 = 244.1, p < 0.001), and they chose more comfort care (χ 2 = 18.8, p < 0.001). Most of cancer patients in the two groups wanted to die at home (72.8 %, 73.7 %, respectively). The older patients (OR, 1.04, 95 % CI, 1.02-1.07, p = 0.001), female (OR, 0.55, 95 % CI, 0.35-0.88, p = 0.013), with higher education levels (OR, 3.38, 95 % CI, 1.92-5.96, p < 0.001), with religious beliefs (OR, 2.91, 95 % CI, 1.71-4.94, p < 0.001), and with higher scores of ECOG (OR, 1.46, 95 % CI, 1.17-1.82, p = 0.001) were associated with desiring for ADs. Conclusions Our findings indicate that there was a dearth of knowledge and different attitudes toward approving ADs among cancer patients, and some factors of demographic and clinical characteristics influenced their willing to designate ADs. This research highlights the importance of propagandizing the ADs to the public, especially to the patients, and further discussing with them when the time is ripe.

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

“…There were no significant differences of willingness to medical treatments between lung cancer patients and caregivers and both patients and healthy people showed their first choice was to receive life saving treatments. Our results were different to those of the study of Zheng et al . in which the majority of patients chose comfort care only, followed by limited care.…”

“…In our study, 94.6% of the patients and 89.9% caregivers had never heard of ADs, and none had signed ADs. Our results were similar to a previous study conducted in China focusing on various cancers, in which all of the 526 cancer patients did not have ADs, and 90% of them had never heard of the terminology of “advance directive”. There were obvious disparities in the comparison of the rate of completion of ADs in China with that of other countries that had AD legislation.…”

“…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.…”

“…Previous studies have indicated that completion of ADs was 14%–30% among the general population, and 15%–49% among cancer patients . Many factors are associated with having ADs including sociodemographic characteristics such as age, level of education, gender, religious beliefs, health or functional status, public education on ADs, and traditional perspectives . Little work has been done on the perception of ADs in both the general and ill populations.…”

Addressing the Needs of International Patients at End of Life in a Tertiary Care Medical Center

“…Multiple factors may contribute to this finding, including the relatively low completion of advance directives around the globe, possibly related to differing regulatory requirements around the globe and significant cultural and religious barriers. [2][3][4] When caring for patients with terminal illnesses, the discussion of end-of-life planning, do-not-resuscitate orders, palliative care consultations, and hospice referrals are all widely accepted practices in Western cultures. However, such practices may not necessarily be congruent with long-standing core religious beliefs about life, death, and the afterlife held by international patients.…”