Department of Nursing, Chi-Mei Medical Center, Liouying, Tainan, Taiwan.
Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
BMC Palliat Care. 2022 Oct 14;21(1):180. doi: 10.1186/s12904-022-01063-7.
End-stage renal disease (ESRD) is a major chronic illness worldwide, and Taiwan reports one of the highest incidence rates of ESRD with 529 cases per million population (pmp). A number of patients with ESRD patients might require lifelong hemodialysis (HD) or peritoneal dialyses (PD). Due to the progression of dialysis, patients are likely to experience other chronic comorbidities, anxiety and depression, frequent hospitalizations, and higher rates of mortality compared to patients with other types of chronic illnesses. As a result, dialysis patients are prone to experience advance care planning (ACP) needs, such as whether they withdraw from receiving dialysis while approaching their end-of-life (EOL). Yet, existing studies have shown that dialysis patients seldom receive timely consultation regarding ACP and there are limited studies examining ACP amongst Taiwan HD patients.
The purpose of this study was to examine ACP awareness, contemplation, self-efficacy and readiness; and factors influencing ACP readiness.
This cross-sectional descriptive study with convenience sampling was conducted in the out-patient HD unit at a regional teaching hospital in southern Taiwan. A total of 143 ESRD patients undergoing HD treatments were recruited. A 55-item ACP engagement survey containing the subscales of awareness, contemplation, self-efficacy, and readiness was employed. The data were analyzed with t-tests, one-way ANOVAs, Pearson's correlations and multiple regressions.
The results of our investigation revealed that approximately half of the participants (n = 67, 46.9%) were not informed of ACP. Although they reported considering their EOL, medical decisions and desired care, they demonstrated significantly low self-efficacy in discussing ACP (t= -5.272, p < 0.001). HD duration influenced all four ACP subscales; religious beliefs significantly influenced ACP-self-efficacy and readiness; and marital status, education, and primary decision-maker status significantly influenced ACP-readiness. The predictors of ACP-readiness were high self-efficacy and being the primary decision-maker (Adjusted R 61%).
Most of the HD patients in this study had low ACP-awareness, contemplation, self-efficacy, and readiness, and most had not completed any ACP-related advance directives (AD). Healthcare professionals should proactively provide HD patients with ACP-related information and answer patients' and medical decision-makers' questions in a timely manner, thereby improving the quality of EOL care.
终末期肾病（ESRD）是全球范围内的一种主要慢性疾病，台湾地区的 ESRD 发病率位居世界前列，每百万人口中有 529 例（pmp）。许多 ESRD 患者可能需要终身接受血液透析（HD）或腹膜透析（PD）治疗。由于透析的进展，与其他类型的慢性病患者相比，患者更容易出现其他慢性合并症、焦虑和抑郁、频繁住院和更高的死亡率。因此，透析患者可能更容易需要进行预先护理计划（ACP），例如在接近生命末期（EOL）时是否停止接受透析。然而，现有研究表明，透析患者很少及时咨询 ACP，并且很少有研究检查台湾 HD 患者的 ACP。
本研究旨在检查 ACP 意识、思考、自我效能和准备情况；并探讨影响 ACP 准备情况的因素。
本研究采用便利抽样法，在台湾南部一家地区教学医院的门诊 HD 病房进行横断面描述性研究。共招募了 143 名正在接受 HD 治疗的 ESRD 患者。采用包含意识、思考、自我效能和准备情况的 55 项 ACP 参与调查。采用 t 检验、单因素方差分析、皮尔逊相关分析和多元回归分析对数据进行分析。
我们的研究结果表明，大约一半的参与者（n=67，46.9%）没有被告知 ACP。尽管他们报告考虑过自己的 EOL、医疗决策和期望的护理，但他们在讨论 ACP 时表现出明显的低自我效能（t=-5.272，p<0.001）。HD 持续时间影响所有四个 ACP 子量表；宗教信仰显著影响 ACP 自我效能和准备情况；而婚姻状况、教育程度和主要决策者状况显著影响 ACP 准备情况。ACP 准备情况的预测因素是高自我效能和作为主要决策者（调整后的 R61%）。
本研究中大多数 HD 患者的 ACP 意识、思考、自我效能和准备情况较低，大多数患者尚未完成任何与 ACP 相关的预嘱（AD）。医疗保健专业人员应主动向 HD 患者提供 ACP 相关信息，并及时回答患者和医疗决策制定者的问题，从而提高临终关怀质量。
