School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong , Hong Kong.
Taipei Veterans General Hospital Yuli Branch, Taipei, Taiwan.
BMC Palliat Care. 2021 Aug 3;20(1):123. doi: 10.1186/s12904-021-00820-4.
The proportion of hospital deaths has declined in the past few decades, while the proportions of nursing home deaths have increased. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs. Under these circumstances, a comprehensive understanding of end-of-life care preferences in local nursing home residents can help healthcare professionals and policymakers develop strategies to increase the advance directive completion rate and quality of care. This study aimed to explore and compare advance directive and end-of-life care preferences of nursing home residents in Hong Kong and Taiwan.
A structured questionnaire was developed by the research team to investigate advance directive and end-of-life care preferences in older Chinese nursing home residents. Nursing home residents with frail or pre-frail status and over the age of 64 were invited to participate in the study, and information on demographics, functional status, advance directive experiences, and end-of-life care expectations was collected through questionnaire interviews.
A total of 325 eligible participants from 32 facilities completed the survey, including 238 older residents in Hong Kong and 87 in Taiwan. A significantly lower proportion of the Hong Kong residents had completed an advance directive compared with the Taiwanese (3 vs. 13%, p = 0.001). Among participants who did not have an advance directive, 46% of the Taiwanese participants said they would consider completing one in the future, compared with 20% of the Hong Kong participants (p < 0.001). A total of 79% of the Hong Kong participants and 80% of the Taiwanese participants responded that prolonging life in the given hypothetical dying scenario was "not important" (p = 0.76). Only 14% of participants in Hong Kong and 18% of participants in Taiwan reported prior occurrence of end-of-life care discussions with family members or health professionals (p = 0.37).
This paper adds evidence in support of improving end-of-life communication and the advance directive completion rate in nursing homes in Hong Kong and Taiwan. Further research is necessary to explore cross-cultural differences in end-of-life preferences and its applications in predicting decision-making and the quality of end-of-life care.
在过去几十年中，医院死亡比例下降，而养老院死亡比例上升。这一趋势突显了在这些环境中改善临终关怀服务的重要性，以满足个人的偏好和需求。在这种情况下，全面了解当地养老院居民的临终关怀偏好，可以帮助医疗保健专业人员和政策制定者制定策略，提高预立医嘱的完成率和护理质量。本研究旨在探讨和比较香港和台湾养老院居民的预立医嘱和临终关怀偏好。
研究团队制定了一份结构化问卷，以调查老年华人养老院居民的预立医嘱和临终关怀偏好。邀请身体虚弱或脆弱且年龄在 64 岁以上的养老院居民参加研究，并通过问卷访谈收集人口统计学、功能状态、预立医嘱经验和临终关怀期望方面的信息。
共有 32 个设施的 325 名符合条件的参与者完成了调查，其中包括 238 名香港老年人和 87 名台湾老年人。与台湾居民相比，香港居民完成预立医嘱的比例明显较低（3%比 13%，p=0.001）。在没有预立医嘱的参与者中，46%的台湾参与者表示他们将来会考虑完成一份，而香港参与者的这一比例为 20%（p<0.001）。79%的香港参与者和 80%的台湾参与者表示，在给定的临终假设情况下，延长生命“不重要”（p=0.76）。只有 14%的香港参与者和 18%的台湾参与者报告说，他们之前曾与家人或医疗保健专业人员讨论过临终关怀（p=0.37）。
本研究为提高香港和台湾养老院的临终关怀沟通和预立医嘱完成率提供了证据支持。进一步的研究有必要探索临终关怀偏好的跨文化差异及其在预测决策和临终关怀质量方面的应用。
