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Advance directive and end-of-life care preferences among nursing home residents in Wuhan, China: a cross-sectional study.
J Am Med Dir Assoc. 2014 Oct; 15(10):751-6.JA

Abstract

OBJECTIVES

To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD.

DESIGN

Population-based cross-sectional survey.

SETTINGS

Nursing homes (n = 31) in Wuhan, Mainland Southern China.

PARTICIPANTS

Cognitively intact nursing home residents (n = 467) older than 60 years.

MEASURES

Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences.

RESULTS

Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098).

CONCLUSIONS

Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.

Authors+Show Affiliations

School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.Faculty of Health, University of Technology Sydney, Sydney, Australia.School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: maojing@hust.edu.cn.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25066002

Citation

Ni, Ping, et al. "Advance Directive and End-of-life Care Preferences Among Nursing Home Residents in Wuhan, China: a Cross-sectional Study." Journal of the American Medical Directors Association, vol. 15, no. 10, 2014, pp. 751-6.
Ni P, Zhou J, Wang ZX, et al. Advance directive and end-of-life care preferences among nursing home residents in Wuhan, China: a cross-sectional study. J Am Med Dir Assoc. 2014;15(10):751-6.
Ni, P., Zhou, J., Wang, Z. X., Nie, R., Phillips, J., & Mao, J. (2014). Advance directive and end-of-life care preferences among nursing home residents in Wuhan, China: a cross-sectional study. Journal of the American Medical Directors Association, 15(10), 751-6. https://doi.org/10.1016/j.jamda.2014.06.006
Ni P, et al. Advance Directive and End-of-life Care Preferences Among Nursing Home Residents in Wuhan, China: a Cross-sectional Study. J Am Med Dir Assoc. 2014;15(10):751-6. PubMed PMID: 25066002.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance directive and end-of-life care preferences among nursing home residents in Wuhan, China: a cross-sectional study. AU - Ni,Ping, AU - Zhou,Jing, AU - Wang,Zhao Xi, AU - Nie,Rong, AU - Phillips,Jane, AU - Mao,Jing, Y1 - 2014/07/22/ PY - 2014/02/25/received PY - 2014/05/23/revised PY - 2014/06/03/accepted PY - 2014/7/29/entrez PY - 2014/7/30/pubmed PY - 2015/6/9/medline KW - Chinese KW - End-of-life care KW - advance directive KW - nursing home SP - 751 EP - 6 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 15 IS - 10 N2 - OBJECTIVES: To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD. DESIGN: Population-based cross-sectional survey. SETTINGS: Nursing homes (n = 31) in Wuhan, Mainland Southern China. PARTICIPANTS: Cognitively intact nursing home residents (n = 467) older than 60 years. MEASURES: Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences. RESULTS: Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098). CONCLUSIONS: Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/25066002/Advance_directive_and_end_of_life_care_preferences_among_nursing_home_residents_in_Wuhan_China:_a_cross_sectional_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(14)00347-8 DB - PRIME DP - Unbound Medicine ER -