The Characteristics and Motivations of Taiwanese People toward Advance Care Planning in Outpatient Clinics at a Community Hospital

Abstract

Advance care planning (ACP) provides access to complete advance decisions (ADs). Despite the legalization of ACP in Taiwan, it is underutilized in community settings. The objective of this study is to describe the service at a community hospital in Southern Taiwan. We retrospectively analyzed participants who were engaged in ACP consultations from January 2019 to January 2020. The characteristics, motivations, content, and satisfaction of participants are reported. Factors associated with refusing life-sustaining treatments (LST) or artificial nutrition/hydration (ANH) were analyzed using multivariate logistic regression. Of the 178 participants, 123 completed the ACP. The majority were female (64.2%), aged 61 on average and more than 80% had never signed a do-not-resuscitate order. In the ADs, most participants declined LST (97.2%) and ANH (96.6%). Family-related issues (48.9%) were the most prevalent motivations. Rural residence (OR 8.6, p = 0.005), increased age (OR 7.2, p = 0.025), and reluctance to consent to organ donation (OR 5.2, p = 0.042) correlated with refusing LST or ANH. Participants provided a positive feedback regarding overall satisfaction (good, 83%) compared to service charge (fair/poor, 53%). The study demonstrated high AD completion when refusing LST or ANH. These findings may facilitate the development of ACP as a community-based service.

Factors Associated with Advance Directives Documentation: A Nationwide Cross-Sectional Survey of Older Adults in Korea

“…Similar to previous research results [ 35 , 36 ], participants who registered for organ donation were more likely to have ADs. This suggests an opportunity to increase awareness and receptivity towards organ donation by including a brief segment on this issue during ACP discussions [ 36 ].…”

Exploring Differential Perceptions and Barriers to Advance Care Planning in Dementia among Asian Patient–Caregiver Dyads—A Mixed-Methods Study

“…ACP encourages people to engage in discussions about future health choices and medical care. From the patients’ perspective, ACP prepares them for death and dying, allows them to exercise control, and relieves loved ones of the burden of decision making [ 3 , 4 , 5 ].…”

Urban people’s preferences for life-sustaining treatment or artificial nutrition and hydration in advance decisions

“…Furthermore, two significant family-related factors contributing to the refusal of LST and ANH treatment were the reluctance of family members to assume responsibility and the rejection of HCA appointment. This mirrors the prevalent ACP issues in Asian culture, which primarily revolve around family-related concerns [ 6 , 15 ]. Sun et al reported instances in which ICU surrogates faced emotional interference from families with conflicting views on medical treatment, thereby influencing decision-making [ 27 ].…”

“…The preference of LST and ANH can be influenced by various factors, including culture, religion, tradition, value and beliefs, administrative guidelines, and the dynamics of the doctor– family–patient relationships [ 1 , 12 – 14 ]. Some studies have highlighted the challenges in providing ANH to the end-of-life patients [ 15 , 16 ]. Patients may require artificial nutrition for a variety of reasons, such as survival, feeling better, or maintaining appearances for the sake of their family [ 3 , 17 ].…”