Advance directives and life-sustaining treatment : attitudes of Hong Kong Chinese elders with chronic disease

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Advance directives and life-sustaining treatment : attitudes of Hong Kong Chinese elders with chronic disease

 

Author: Ting, Hung Fion
Title: Advance directives and life-sustaining treatment : attitudes of Hong Kong Chinese elders with chronic disease
Degree: M.Sc.
Year: 2011
Subject: Hong Kong Polytechnic University -- Dissertations
Chronically ill -- Psychological aspects -- China -- Hong Kong.
Older people -- China -- Hong Kong -- Psychology
Department: School of Nursing
Pages: xiii, 126 p. : ill. ; 30 cm.
InnoPac Record: http://library.polyu.edu.hk/record=b2412269
URI: http://theses.lib.polyu.edu.hk/handle/200/5978
Abstract: Background: The advances in medical technology and ageing population have led to increasing attention on the issues of end-of-life care. In Hong Kong, elders with chronic disease make up a large proportion in the healthcare system. This group of patient is more susceptible to mortality and mental incompetence. Advance directives and related issues are particularly relevant to them. However, there is little data on the attitudes of local elders with chronic disease on advance directives and life-sustaining treatment. With the increasing survival of elderly with chronic disease, there is a pressing need to explore their attitudes on that area. Aim: To examine the attitudes of Hong Kong Chinese elders with chronic disease with regard to advance directives and life-sustaining treatment. Design: A cross sectional survey was carried out in the in-patient medical wards of a regional teaching hospital in Hong Kong. Advance directives and related concepts were explained to the participants before they were interviewed to ensure they had sufficient background information to give informed attitudes. Quantitative data regarding their attitudes towards the use of advance directives and life-sustaining treatment were collected. Results: A total of 219 elderly patients completed the survey. Their mean age was 73 (standard deviation, 8) years and 133 (60.7%) of them were female. The majority had neither heard about advance directives (81.3%) nor discussed the issue with others (72.6%) before participating in this study. After they were informed of the concept of advance directives, about half (49.3%) of them said they would consider using it if it had been legislated in Hong Kong. The respondents generally supported the withholding or withdrawing of life-sustaining treatment in medically futile situations. 54.8% of them believed that the patient alone should make the decision on withholding or withdrawing life-sustaining treatment if competent to do so. If the patient was not competent, 43.8% believed that the patient's family alone should make the decision. However, despite having specific life-sustaining treatment preferences and strong support for the practice of limiting life-sustaining treatment using in medical futility situations, many of the respondents seldom thought (62.6%) or talked about these issues (72.6%) with other. Conclusion: The majority of the elderly patients in this study not only were able to take side rather than being undecided, they also showed a positive attitude towards the used of advance directives and limited use of life-sustaining treatment in medical futility situations. However, despite their open-mindedness, most of the respondents had never heard about advance directives or discussed the related issues with others. This points to a lack of knowledge and to the necessity to step up public education about advance directives and related issues.

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