Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
Int J Environ Res Public Health. 2021 Jan 7;18(2):417. doi: 10.3390/ijerph18020417.
(1) Background: Since Taiwan's Patient Right to Autonomy Act took effect in 2019, up to ten thousand declarants have participated in advance care planning (ACP) and have signed advance directives (ADs). Relative to the entire population of Taiwan, only a small percentage have completed ACP. This study sought to understand the motivations of Taiwanese who have participated in ACP, so as to increase the percentage of individuals participating in ACP and signing ADs; (2) Objectives: To understand the motivations that drive Taiwanese individuals to participate in ACP discussions.; (3) Methods: A retrospective secondary data analysis was performed in this study. The participants consisted of declarants who completed their ACP at a medical center in Taiwan in 2019; (4) Results: During the study period, 946 individuals completed their ACP. Of those declarants, 66.7% were over 60 years of age; 66.5% completed the process in groups of three or more; 49.5% completed their ACP free of charge; and 35 declarants had designated a health care agent (HCA). The declarants' four main motivations for participating in ACP were "looking forward to dying with dignity," "making end-of-life preparations," "fear of being a social and economic burden on family members," and "reluctance to let family members take on the responsibility of making decisions." Furthermore, statistically significant differences were observed between the declarants in terms of gender, age, designation of an HCA, and motivations for participating in ACP. Females, declarants aged below 60 years, and declarants with a designated HCA tended to participate in ACP due to "reluctance to let family members to take on the responsibility of making decisions". Males, declarants aged above 60 years, and declarants without an HCA came for ACP because of "fear of being a social and economic burden on family members". (5) Conclusions: The main motivations of Taiwanese individuals who sought ACP were to die with dignity and to have an early understanding of end-of-life treatment and care models. Secondly, these individuals hoped that their families would not have to take on the responsibility of making decisions. They also did not want to impact their families socially and economically. In this regard, providing economic subsidies might enhance the Taiwanese public's intentions to seek ACP discussions on their own initiative.
(1) 背景：自 2019 年台湾《病人自主权利法》生效以来，已有上万名宣告人参与预立医疗照护谘商并签署预立医疗决定，然而相对于台湾总人口数，仅小部分人完成预立医疗照护谘商并签署预立医疗决定。本研究旨在了解参与预立医疗照护谘商的动机，以增加主动参与预立医疗照护谘商并签署预立医疗决定的人数；(2) 目的：了解促使台湾人参与预立医疗照护谘商的动机；(3) 方法：本研究采用回顾性二次数据分析。参与者为 2019 年在台湾某医学中心完成预立医疗照护谘商的宣告人；(4) 结果：在研究期间，946 人完成了预立医疗照护谘商。其中，66.7%的参与者年龄在 60 岁以上；66.5%的参与者以三人或以上的团体形式完成谘商；49.5%的参与者免费完成谘商；35 名宣告人指定了医疗照护委任代理人。参与者参与预立医疗照护谘商的四个主要动机是“期待有尊严地离世”、“为临终做准备”、“害怕成为家庭成员的社会和经济负担”和“不愿让家庭成员承担决策责任”。此外，在性别、年龄、指定医疗照护委任代理人以及参与预立医疗照护谘商的动机方面，宣告人之间存在显著差异。女性、60 岁以下的宣告人和指定了医疗照护委任代理人的宣告人，往往是因为“不愿让家庭成员承担决策责任”而参与预立医疗照护谘商。男性、60 岁以上的宣告人和没有指定医疗照护委任代理人的宣告人，是因为“害怕成为家庭成员的社会和经济负担”而参与预立医疗照护谘商。(5) 结论：台湾人寻求预立医疗照护谘商的主要动机是有尊严地离世，并对临终治疗和护理模式有早期的了解。其次，这些人希望家人不必承担决策责任，也不希望对家庭的社会和经济造成影响。在这方面，提供经济补贴可能会增强台湾民众主动寻求预立医疗照护谘商的意愿。
