Health Professionals' Knowledge, Attitudes, Experiences, Confidence, and Behaviors Regarding Advance Directives

Sunday, 30 July 2017

Shu-Fen Wu, MSN, RN1
Hong-Yi Tung, MS2
Yu-Hua Lin, PhD, RN3
Chao-Hsien Lee, PhD4
Hsiu-Chen Liao, BSN5
Ching-Yun Ching, BSN5
(1)Department of Anesthesiology, E-Da Dachang Hospital, Kaohsiung, Taiwan
(2)Department of Medical Education & Research, Yuan’s General Hospital, Kaohsiung, Taiwan
(3)Department of Nursing, I-Shou University, Kaohsiung, Taiwan
(4)Department of Health Business Administration, Meiho University, Pingtung, Taiwan
(5)Department of Nursing, Yuan’s General Hospital, Kaohsiung, Taiwan


 Advance directives (ADs) are one of the few means for people to indicate their end-of-life treatment decision preference. The purpose of this study was to determine the ADs compaction knowledge, attitudes, experiences, confidence, and behaviors of health professions.


 This was a descriptive correlational research that targeted 765 subjects (included 43 physicians, 424 nurses, 85 other medical staffs, and 213 administration staffs) working in a regional hospital in southern Taiwan. The structured questionnaires gathered the knowledge, attitudes, experiential survey on advance directives (KAESAD) instrument and basic demographic data with regard to advance directives. Data were analyzed by using SPSS 20.0 software. Descriptive statistics, independent t test, chi-square test (x2), Pearson product-moment correlation, one way ANOVA, and Binary logistic regression were used for data analysis.


 The results indicated that signing advance directives consent form is low. Only 1.8% of the health professionals had completed advance directives, although 86. 3% indicated their willingness to have one. The first two reasons for signing include: not want to be burden on their family (85.9%), and ensure the quality at end-of-life (85.5%). The first two reasons why health professionals do not want to sign are: they still have plenty of time to make end-of-life decision (33.3%), and self-perceived health status (31.0%). Age, working years, and attitudes were found to correlate positively with knowledge. Knowledge, attitudes, and experiences were found to correlate positively with confidence. The result of questionnaire survey, the total knowledge, experience of ADs scores and total confidences is low, held positive attitudes toward ADs. Between groups that physicians have more knowledge, attitudes, experiences, and confidence of ADs compared with other groups. In addition the mean scores for professional experiences with end of life decision-making were low in physicians with nurses (physicians 56.00±3.54; nurses 57.16±4.80). Have “relatives and friends suffering from serious illness experience” and heard “advance hospice palliative care & life-sustaining treatment choices of intent” could be used as predictive factors for ADs in nurse group (Nagelkerke R Square= .082). The self is the primary medical decision maker and have “relatives and friends suffering from serious illness experience” could be used as predictive factors for ADs in other medical staffs group (Nagelkerke R Square= .292). Have “relatives and friends were suffering from serious illness experience”, not heard “any advance hospice palliative care document” and “have experience of ADs” could be used as predictive factors for ADs in administration staffs group (Nagelkerke R Square= .123).


The study findings showed that health professionals’ have insufficient knowledge, inadequate practices, and had lower completion rate of ADs. Such indicates the need for designing different of clinical educational programming to provide health personnel's knowledge and experience and enhance ADs facilitation effectiveness.