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

Ni, P; Zhou, J; Wang, ZX; Nie, R; Phillips, J; Mao, J

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

Ni, P Zhou, J Wang, ZX Nie, R Phillips, J Mao, J

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Publication Type:: Journal Article
Citation:: Journal of the American Medical Directors Association, 2014, 15 (10), pp. 751 - 756
Issue Date:: 2014-01-01

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Field	Value	Language
dc.contributor.author	Ni, P	en_US
dc.contributor.author	Zhou, J	en_US
dc.contributor.author	Wang, ZX	en_US
dc.contributor.author	Nie, R	en_US
dc.contributor.author	Phillips, J	en_US
dc.contributor.author	Mao, J	en_US
dc.date.issued	2014-01-01	en_US
dc.identifier.citation	Journal of the American Medical Directors Association, 2014, 15 (10), pp. 751 - 756	en_US
dc.identifier.issn	1525-8610	en_US
dc.identifier.uri	http://hdl.handle.net/10453/43667
dc.description.abstract	© 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Objectives: To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD. Design: Population-based cross-sectional survey. Settings: Nursing homes (n= 31) in Wuhan, Mainland Southern China. Participants: Cognitively intact nursing home residents (n= 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 life-sustaining 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.	en_US
dc.relation.ispartof	Journal of the American Medical Directors Association	en_US
dc.relation.isbasedon	10.1016/j.jamda.2014.06.006	en_US
dc.relation.isreplacedby	10453/120113
dc.relation.isreplacedby	http://hdl.handle.net/10453/120113
dc.subject.classification	Geriatrics	en_US
dc.title	Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study	en_US
dc.type	Journal Article
utslib.citation.volume	10	en_US
utslib.citation.volume	15	en_US
utslib.for	1117 Public Health And Health Services	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.declined	2016-04-19T17:23:56.336+1000
pubs.merge-to	10453/120113
pubs.merge-to	http://hdl.handle.net/10453/120113
pubs.deleted	2016-04-19T17:23:56.336+1000
pubs.issue	10	en_US
pubs.publication-status	Published	en_US
pubs.volume	15	en_US

Abstract:

© 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Objectives: To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD. Design: Population-based cross-sectional survey. Settings: Nursing homes (n= 31) in Wuhan, Mainland Southern China. Participants: Cognitively intact nursing home residents (n= 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 life-sustaining 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.

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http://hdl.handle.net/10453/43667