Investigating the association between health literacy and life-sustaining treatment preferences of residents in coastal area in midland of Taiwan

• Main Authors: Ping-Hsueh Lee, 李秉學
• Other Authors: Fu-Chang Tsai
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/kc9xpg

碩士 === 國立臺灣大學 === 醫學教育暨生醫倫理研究所 === 106 === Background The decision of life-sustaining treatment(LST) remains an important issue in end-of-life care. Whether or not treatments conformed to a terminal patient’s expressed will deeply influence quality of end-of-life care. The Patient Autonomy Act will be launched in near future, which pushed everyone to think the goal of medical care he/she wished in certain difficult situations, including persistent vegetative state (PVS), severe dementia, deep coma, terminal diseases and intolerable suffering. Health literacy was related to willingness to sign advance directives (AD). It was also related to the type and quality of doctor-patient communication. Up to now no study depict the choices of general population in situations mentioned in Patient Autonomy Act in Taiwan. In addition, few studies investigate the associations between LST preferences and possibly related factors, including health literacy. Objective Through questionnaire, the objective of the study is to investigate the picture of end-of-life values in general population, as well as their LST choices in situations described in Patient Autonomy Act. The study also aimed at investigating the association between LST preferences and possibly related factors, including health literacy. Method In the questionnaire, we listed several end-of-life values for respondents to evaluate and rank. We used Short-form Mandarin Health Literacy Scale to measure respondents’ health literacy. We used modified Life Support Preferences Questionnaire (LSPQ) to attain respondents’ end-of-life preferences. Four situations (Amyotrophic Lateral Sclerosis, severe dementia, permanent vegetative state and terminal cancer) and 7 LST (antibiotics, nasogastric tube, blood transfusion, hemodialysis, gall bladder surgery, intubation with mechanical ventilation and cardiopulmonary resuscitation) were included in the modified LSPQ. Basic demographic data were collected in the end of the questionnaire. We used convenience sampling method to collect our data in the serving area of a regional teaching-hospital in middle Taiwan. All respondents completed the questionnaire independently without language aid. Result One hundred and seventy-eight valid questionnaires were obtained, with a response rate of 99.99%. The top-three rated end-of-life issues were：whether clear consciousness could be regained after a LST, whether mobility could be recovered after a LST and if the resulting condition after a LST caused heavy financial burden. Compared to men, women respondents put more emphasis on the issue of causing financial burden after a LST. Respondents’ preferences varied through 4 clinical situations and 7 LSTs：The worse the consciousness in clinical situations and the shorter life expectancy, the more likely a respondent to refuse a LST. Also, the more invasive a LST was, the more likely a respondent to refuse it. In univariate analysis, health literacy was significantly related to gender, education, marital status, occupations, and religion；LST preferences were significantly related to gender, number of children and health literacy. All the eight variables mentioned above were put into the multivariate logistic regression model, which revealed：LST preferences were significantly associated with gender, number of children, education level, religion, occupation and health literacy. In certain situation with specific treatment option, respondents who were woman, having more than 2 children and with higher education level were more likely to refuse a LST. As to health literacy, in situations of severe dementia and permanent vegetative state, respondents with higher health literacy score were more likely to refuse intubation with mechanical ventilation(Odds Ratio：0.758，95%CI：0.59~0.972, p=0.029；0.751，95%CI：0.578~0.976, p=0.032, respectively). The likelihood of which a respondent choose a LST decreased by 25%~30% with every score increased in health literacy scale. Other demographic data, such as age, marital status, family income, depression, quality of life, comorbidity and prior experience of a LST were not significantly associated with all LST preferences in any situations in our study. Conclusion LST preferences varied with clinical situations and type of LST. Gender, number of children, religion, occupation and health literacy were significantly related to LST preferences. Physicians should pay attentions to these factors when he/she encountered an end-of-life decision-making. Health care institutions should allocate more resources in developing effective communication tools for subjects with low health literacy, to achieve better quality in end-of-life decision making process.