The role of life-sustaining treatment witnessed experiences on informed end-of-life choices among the elderly in China.

BACKGROUND

Informed decision-making is pivotal for end-of-life (EOL) care aligns with patients' preferences, thereby enhancing the quality of dying. However, limited research has analyzed how individuals' prior exposure to life-sustaining treatment (LST) shapes informed EOL choices. This study addresses this gap by investigating the impact of LST witnessed experiences on EOL decision-making among the elderly in China.

METHODS

We conducted a cross-sectional analysis of primary data from 571 elderly residents in a public nursing home. Logistic regression and marginal effect analyses were performed to examine associations between LST witnessed experiences and informed EOL choices. LST witnessed experiences were categorized into five items: cardiopulmonary resuscitation (CPR), tracheal intubation, tube feeding, expensive antibiotics use, and hemodialysis. We assessed variations in marginal effects across these five LST items. Subgroup analyses evaluated differences stratified by education levels and monthly pension. Partial correlations analyses and interaction effect analyses were further employed to investigate the dual role of death taboo in mediating both LST witnessed experiences and informed EOL choices.

RESULTS

Elderly individuals with LST witnessed experiences exhibited a higher demand for informed EOL care (OR = 1.551, 90% CI: 1.095 to 2.196, p < 0.05) compared to those without LST witnessed experiences. There was 7.5 percentage-point increase in the predicted probability of choosing informed EOL care (90% CI: 0.016 to 0.134, p < 0.05) associated with LST witnessed experiences. Specifically, witnessing CPR (incremental effect = 0.079, 90% CI: 0.003 to 0.155, p < 0.1) and tube feeding (incremental effect = 0.085, 90% CI: 0.020 to 0.150, p < 0.05) significantly influenced informed EOL choices. Subgroup analyses revealed that these effects were stronger among individuals with lower educational attainment and monthly pensions.

CONCLUSIONS

LST witnessed experiences were significantly associated with more informed EOL choices among the elderly, highlighting the role of firsthand medical experiences in shaping care preferences. To optimize EOL decision-making, targeted death education programs-particularly for socioeconomically disadvantaged groups with limited health literacy-are critical in clinical and community settings.