The readiness and associate factors of implementing living wills among healthcare providers in Shenzhen: a cross-sectional study

Abstract

Background On January 1st, 2023, Shenzhen became the first city to legalize living wills in China. Although this unprecedented legalization, less was known about the readiness of Healthcare Professionals (HCPs) in Shenzhen in terms of implementing this Act. Our team aimed to timely examine the HCPs’ readiness in Shenzhen during the early stage of the regulation, including their knowledge, attitude and confidence to implement living wills. Methods A cross-sectional study was conducted across 16 hospitals in Shenzhen, Mainland Southern China, comprising 12 Grade III hospitals, 2 Grade II hospitals, and 2 Grade I hospitals selected for convenience. A total of 685 registered physicians or nurses participated in the study. Electronic questionnaires were employed to collect data on the demographics, knowledge, attitudes, and confidence levels of HCPs. Results Among 685 participants, less than half of them (315, 46.0%) had adequate knowledge (score ≥ 9), and the average correct rate of knowledge was 65.4%. Most (94.0%) of participants had a positive attitude (with a score ≥ 16). About 87.0% of the participants got the higher score (≥ 16) in the confidence-to-implement assessment. The significant predictors of knowledge included having cared for terminally ill patients (OR = 1.391), income less than $4,176 per month (OR = 1.628), holding administrative positions (OR = 0.611). HCPs with bachelor’s degree (OR = 3.348) and master’s degree or above (OR = 2.645), having cared for terminal ill patients (OR = 2.564) were more likely to get positive attitude. Additionally, HCPs who participated in specific training programs on living wills (OR = 1.703) and had cared for terminal ill patients (OR = 3.035) were more likely to hold higher level of confidence. Conclusions Although living wills have been legalized in Shenzhen, China, HCPs are not sufficiently prepared to implement it. They get general knowledge, hold positive attitude, but are lacking legal-related knowledge or enough confidence to implement living wills. Training programs addressing living will implementation, especially including legal awareness training, understanding the roles of different HCPs in executing living wills, and how to respect patient autonomy in Chinese culture should be planned at an early stage of a policy issued.