| Summary: | 碩士 === 國立臺北護理健康大學 === 護理研究所 === 107 === Background：Advance care planning (ACP) is an essential topic in the current medical system of Taiwan. While promoting the autonomy and dignity of disabled elderly individuals, it is crucial to encourage chronically disabled elderly people and their family members to learn more about ACP. It helps to increase understanding of whether the medical care and treatment for advanced illness meet the expectations of patients’ family members, which influences the quality of end-of-life care significantly. However, few studies had reported on opportunities to discuss ACP or complete the signing of advance directives (AD), among the family members of home-based individuals who are disabled and elderly.
Objective：The purpose of this study was twofold. It investigates the correlation between awareness of advance medical planning, preferences for life-sustaining measures, and signing of advance medical directives in disabled elderly persons living at home and that of family caregivers. Additionally, it attempts to understand the major predictors for determining awareness of advance medical planning, preferences for life-sustaining measures, and signing of advance medical directives by disabled elderly persons living at home and that of family caregivers.
Methods：It employed a cross-sectional correlational design and enrolled disabled elderly individuals, and their primary caregivers, admitted by affiliated home care centers of regional teaching hospitals in Hsinchu. The Life Support Preferences Questionnaires (LSPQ) was adopted as the tool for measuring the elderlies’ and caregivers' willingness to make medical decisions between January and June 2018. Cases were enrolled through convenience sampling and face-to-face interviews were conducted; 75 pairs of valid samples were collected in total. The collected data were then statistically analyzed with SPSS22.0 software.
Results：(1) The preferences for life-sustaining measures of disabled elderly persons living at home differed depending on gender, educational levels, current levels of disability, and when disabilities were diagnosed. (2) The preferences for life-sustaining measures of primary family caregivers differed depending on age, gender, and educational levels. (3) Awareness of advance medical planning of disabled elderly persons living at home was negatively correlated with age and the decision to sign advance medical directives. (4) The preferences for life-sustaining measures of primary family caregivers were negatively correlated with awareness of advance medical planning and positively correlated with the decision to sign advance medical directives. Awareness of advance medical planning was negatively correlated with age and the decision to sign advance medical directives and positively correlated with caregiver burden. (5) The average score of awareness of advance medical planning by the primary family caregivers (1.85 ± 0.88) was higher than that of the patients (1.41 ± 0.90). Similarly, the score of preferences for life-sustaining measures of family caregivers was also higher than that of the patients (0.82 ± 0.79). This shows that the preferences for life-sustaining measures of the primary caregivers are more uncertain than those of the patients themselves. (6) After controlling for the basic attribute variables of disabled elderly persons, the factors affecting awareness of advance medical planning are the current level of disability and the decision to sign advance medical directives, which explained the variance of 49%. (7) After controlling for the basic attribute variables of the primary family caregivers, the major predictors affecting their decision to sign advance medical directives are the preferences for life-sustaining measures of the patient and awareness of advance medical planning, which explained the increase of the variance to 36%.
Conclusions：Our study providing the disabled elderly and their family members with appropriate and easy-to-understand medical information can increase their willingness to participate in medical decision-making. Thus, health care worker should assist disabled elderly persons living at home and their caregivers by providing consultations and discussions on their preferences in, and awareness of, end-of-life care. This should be done in order to implement advance medical planning as soon as possible, which allows appropriate medical care to be rendered according to the patient’s wishes. It is expected that the results of this study will provide a reference for home-based medical staff to improve the quality of home-care services.
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