Advance Decision Behavioral Intention and Related Factors in Adults Living in the Community

Abstract

Improvements in medical science and technology have increased the average number of years that older adults survive with impaired quality of life. Understanding behavioral intentions and related factors affecting advance decision (AD) decision-making can help medical professionals improve the decision-making ability of patients, allowing patients and their family members to make better medical decisions that reduce ineffective medical treatments, improve quality of life, and facilitate a good death. This study was developed to explore behavioral intentions and related factors during the process of AD decision-making among community adults. A cross-sectional study design was used in this study. The knowledge, attitudes, and behavioral intentions regarding AD decisions, spiritual health, and social support were measured in a convenience sample using physical or internet-based questionnaires. Data were analyzed in SPSS 21.0 using descriptive and independent samples t-tests, one-way ANOVA, Pearson correlation, and multiple regression analysis. Three hundred and seventy-seven community adults participated in this research (50.57 years old, SD = 13.39; 58.4% female). The average level of AD-related behavioral intention was found to be high, with high numbers of participants indicating that they would refuse endotracheal intubation (4.13, SD = 0.92), extracorporeal membrane oxygenation (4.09, SD = 0.95), extracorporeal heart massage (4.08, SD = 0.95), and defibrillation (4.08, SD = 0.98) if they were in a permanent vegetative state in the future. The important predictors of AD behavioral intention included gender, written expression of end-of-life medical decision-making, participation in the patient self-rights law and advance decision publicity lectures, having an advance decision attitude, and social support (R2 = 40.1%, p < .001). A high level of AD-related behavioral intention was found in the sample and several important factors that influence related behaviors were identified. These results provide an important reference for related public policymakers to increase the percentage of older patients participating in advance directive decision-making.