scholarly journals Overview of the Motivation of Advance Care Planning: A Study from a Medical Center in Taiwan

2021 ◽  
Vol 18 (2) ◽  
pp. 417
Author(s):  
Yi-Jhen He ◽  
Ming-Hwai Lin ◽  
Jo-Lan Hsu ◽  
Bo-Ren Cheng ◽  
Tzeng-Ji Chen ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Economic Burden ◽  
Medical Center ◽  
Family Members ◽  
Secondary Data ◽  
Care Planning ◽  
Care Models ◽  
Advance Care ◽  
Health Care Agent

(1) Background: Since Taiwan’s Patient Right to Autonomy Act took effect in 2019, up to ten thousand declarants have participated in advance care planning (ACP) and have signed advance directives (ADs). Relative to the entire population of Taiwan, only a small percentage have completed ACP. This study sought to understand the motivations of Taiwanese who have participated in ACP, so as to increase the percentage of individuals participating in ACP and signing ADs; (2) Objectives: To understand the motivations that drive Taiwanese individuals to participate in ACP discussions.; (3) Methods: A retrospective secondary data analysis was performed in this study. The participants consisted of declarants who completed their ACP at a medical center in Taiwan in 2019; (4) Results: During the study period, 946 individuals completed their ACP. Of those declarants, 66.7% were over 60 years of age; 66.5% completed the process in groups of three or more; 49.5% completed their ACP free of charge; and 35 declarants had designated a health care agent (HCA). The declarants’ four main motivations for participating in ACP were “looking forward to dying with dignity,” “making end-of-life preparations,” “fear of being a social and economic burden on family members,” and “reluctance to let family members take on the responsibility of making decisions.” Furthermore, statistically significant differences were observed between the declarants in terms of gender, age, designation of an HCA, and motivations for participating in ACP. Females, declarants aged below 60 years, and declarants with a designated HCA tended to participate in ACP due to “reluctance to let family members to take on the responsibility of making decisions”. Males, declarants aged above 60 years, and declarants without an HCA came for ACP because of “fear of being a social and economic burden on family members”. (5) Conclusions: The main motivations of Taiwanese individuals who sought ACP were to die with dignity and to have an early understanding of end-of-life treatment and care models. Secondly, these individuals hoped that their families would not have to take on the responsibility of making decisions. They also did not want to impact their families socially and economically. In this regard, providing economic subsidies might enhance the Taiwanese public’s intentions to seek ACP discussions on their own initiative.

Association Between Advance Directives and Quality of End-of-Life Care (DRAFT)

2018 ◽  
Author(s):  
Donna S. Zhukovsky
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Family Members ◽  
Care Planning ◽  
Life Care ◽  
Care Providers ◽  
Advance Care

Advance care planning is a complex process whereby an individual reflects on future care options at the end of life after reflecting on his or her values and goals for care. These values, goals, and preferences are then communicated to key stakeholders in the process (i.e., proxy and surrogate decision-makers, family members, and health care providers). It is unclear how well the completion of advance directives and a written outcome of advance care planning affect desired patient outcomes. In this chapter, a critical review is provided of a mortality follow-back survey that evaluates the association of advance directives with quality of end-of-life care from the perspective of bereaved family members. Study strengths and limitations are described, as are directions for future research.

“It’s about the conversation”: A multidisciplinary intervention to support advance-care planning.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 111-111 ◽  
Author(s):  
Finly Zachariah ◽  
Linda Klein ◽  
Nancy Clifton-Hawkins ◽  
Becky Andrews ◽  
Andrea McQueary ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Medical Center ◽  
Care Planning ◽  
Innovative Strategies ◽  
Resource Center ◽  
Family Resource ◽  
Advance Care ◽  
Surrogate Decision

111 Background: A recent California Healthcare Foundation study found that 60% of Californians highly valued “making sure their families are not burdened by tough decisions about their care." However, less than 50% have communicated their end-of-life wishes to their surrogate decision maker. 82% say it is important to have end-of-life wishes in writing, but only 23% say they have done so. At City of Hope National Cancer Medical Center (COH) the advance directive (AD) completion rate is less than 15%. The Department of Supportive Care Medicine Sheri & Les Biller Patient and Family Resource Center (BRC) is leading development of innovative strategies to foster Advance Care Planning (ACP) communication and documentation. Methods: A multi-specialty physician and interdisciplinary team assembled and designed a social media advertised 4-hour interactive event that was held in the BRC. Over 40 staff and volunteers facilitated individualized ACP conversations with the “Go Wish” cards, private consultations with social workers, showed novel COH ACP videos, provided multi-lingual ACP literature and advance directive documents available for completion with Notary support on-site. Results: Over 300 people attended, including patients, caregivers and COH staff. Forty-seven advance directives were completed (24 by patient/caregivers, 23 by COH staff). Twenty-nine Go Wish games were facilitated (2 in Spanish). Of the 52 attendees who completed exit evaluations, 44% were patients, 31% staff, and 11% were caregivers. Respondents reported that the event increased their comfort and likelihood of having conversations about ACP with others. Importantly, 38 of the 52 surveyed, did not have an AD prior to attending the event. Of those 38 attendees, 18 of them completed an AD at the event (or 47%). Conclusions: Advanced care planning is an all too often avoided conversation that results in increased distress of patients, families and providers. By proactively designing opportunities for facilitated conversations in dynamic and public arenas, fear and stigmas are diffused and the true focus and intent of discovering what people wish so the medical team, surrogates and family can ensure their values are honored and met become possible.

scholarly journals How Acculturation Influences Attitudes About Advance Care Planning and End-of-life Care Among Chinese Living in Taiwan, Hong Kong, Singapore, and Australia

2021 ◽  
Author(s):  
Fu-Ming Chiang ◽  
Jyhgang Hsieh ◽  
Ying-Wei Wang
Keyword(s):  
Hong Kong ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Family Members ◽  
Individual Autonomy ◽  
Clear Understanding ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Abstract Background ： Understanding attitudes towards life and death issues in different cultures is critical in end-of-life care and the uptake of advance care planning (ACP) in different countries. However, existing research suffers from a lack of cross-cultural comparisons among countries. By conducting this comparative study, we hope to achieve a clear understanding of the linkages and differences among healthcare cultures in different Chinese societies, which may serve as a reference for promoting ACP by considering cultural differences. Methods ： Our researchers recruited Chinese adults who could communicate in Mandarin and lived in metropolitan areas in Taiwan, Hong Kong, Singapore, and Australia. Focus group interviews were conducted, and the interview contents were recorded and subjected to thematic analysis. Results ： Between June and July 2017, 14 focus groups with 111 participants were conducted in four regions. With traditional Chinese attitudes towards death as a taboo, many participants felt it would be challenging to discuss ACP with elderly family members. Most participants also desire to avoid suffering for the self and family members. Although the four regions' participants shared a similar Chinese cultural context, significant regional differences were found in the occasions at which participants would engage in end-of-life discussions and select settings for end-of-life care. By contrast, participants from Singapore and Australia exhibited more open attitudes. Most participants from Taiwan and Hong Kong showed a preference for end-of-life care at a hospital. Conclusions ： The developmental experiences of ACP in Western countries, which place a strong emphasis on individual autonomy, cannot be directly applied to family-centric Asian ones. Healthcare professionals in Asian societies should make continuous efforts to communicate patient status to patients and their family members to ensure family involvement in decision-making processes.

scholarly journals Advance Care Planning Among Patients With Advanced Cancer

2019 ◽  
Vol 15 (1) ◽  
pp. e65-e73 ◽  
Author(s):  
Jane R. Schubart ◽  
Benjamin H. Levi ◽  
Megan M. Bain ◽  
Elana Farace ◽  
Michael J. Green
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Decision Aid ◽  
Family Members ◽  
Care Planning ◽  
Life Care ◽  
Physician Awareness ◽  
Advance Care

Purpose: Advance directives (AD) have been heralded as vehicles to promote patient autonomy and have been decried as ineffective. Efforts to improve advance care planning (ACP) and AD documents are wide ranging but have not been prospectively studied. Materials and Methods: In an institutional review board–approved, single-blind, randomized, controlled trial, we compared an interactive, educational ACP decision aid to standard ACP among patients with advanced cancer. We hypothesized that use of the decision aid would increase physician awareness of patients’ health care wishes and increase physician adherence to patients’ end-of-life wishes compared with standard ACP. Results: A total of 200 patients were randomly assigned to two study arms. We analyzed data from medical records and interviews with physicians and family members for 121 patients who died by August 2016. No differences in physician awareness or adherence were found between the ACP decision aid and standard ACP groups. End-of-life treatment wishes and discussion of wishes were documented for 70% and 64% of the patients, respectively, but only 35% had an actual AD in the medical record. According to family members, end-of-life care was consistent with the patients’ stated wishes 94% of the time. Similarly, according to physicians, it was consistent for 98%. However, according to AD documents, delivered care was consistent with desired care in only 65%. Considerably fewer patients than predicted died, and data from physicians were difficult to obtain. Conclusion: ACP type did not influence documentation of patient wishes or end-of-life care received. Future prospective studies must account for challenges in prognostication and point-of-care data collection at the end of life.

scholarly journals How Acculturation Influences Attitudes about Advance Care Planning and End-of-Life Care among Chinese Living in Taiwan, Hong Kong, Singapore, and Australia

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1477
Author(s):  
Fu-Ming Chiang ◽  
Ying-Wei Wang ◽  
Jyh-Gang Hsieh
Keyword(s):  
Hong Kong ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Family Members ◽  
Individual Autonomy ◽  
Clear Understanding ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Background: Understanding attitudes towards life and death issues in different cultures is critical in end-of-life care and the uptake of advance care planning (ACP) in different countries. However, existing research suffers from a lack of cross-cultural comparisons among countries. By conducting this comparative study, we hope to achieve a clear understanding of the linkages and differences among healthcare cultures in different Chinese societies, which may serve as a reference for promoting ACP by considering cultural differences. Methods: Our researchers recruited Chinese adults who could communicate in Mandarin and lived in metropolitan areas in Taiwan, Hong Kong, Singapore, and Australia. Focus group interviews were conducted, and the interview contents were recorded and subjected to thematic analysis. Results: Between June and July 2017, 14 focus groups with 111 participants were conducted in four regions. With traditional Chinese attitudes towards death as a taboo, many participants felt it would be challenging to discuss ACP with elderly family members. Most participants also desire to avoid suffering for the self and family members. Although the four regions’ participants shared a similar Chinese cultural context, significant regional differences were found in the occasions at which participants would engage in end-of-life discussions and select settings for end-of-life care. By contrast, participants from Singapore and Australia exhibited more open attitudes. Most participants from Taiwan and Hong Kong showed a preference for end-of-life care at a hospital. Conclusions: The developmental experiences of ACP in Western countries, which place a strong emphasis on individual autonomy, cannot be directly applied to family-centric Asian ones. Healthcare professionals in Asian societies should make continuous efforts to communicate patient status to patients and their family members to ensure family involvement in decision-making processes.

The implications of the Mental Capacity Act (MCA) 2005 for advance care planning and decision making

2018 ◽  
Author(s):  
Simon Chapman ◽  
Ben Lobo
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Best Interest ◽  
Policy And Practice ◽  
Advance Care ◽  
Current Context ◽  
Mental Capacity Act ◽  
End Of Life Decision

This chapter provides an overview of the MCA’s impact on end-of-life care. It situates the MCA in the current context of policy and practice. It describes how the MCA can be used to improve care, enable people to express and protect choices, and empower and enable the professional and/or the proxy decision maker. It also presents an introduction and explanation of the role of the IMCA and how it might apply to advance care planning (ACP) and end of life decision making, and an explanation of the legal and ethical process involved in reaching best interest decisions, especially for potentially vulnerable people in care homes and other settings.

Sign in / Sign up

Export Citation Format

Share Document