Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
권호 표지
DOI QR코드

DOI QR Code

Factors that Influence Attitudes toward Advance Directives among Hemodialysis Patients

  • Minhee Cho (The Catholic University of Korea, Uijeongbu ST. Mary's Hospital) ;
  • Hyunjoo Na (College of Nursing, The Catholic University of Korea)
  • Received : 2023.07.03
  • Accepted : 2023.12.17
  • Published : 2024.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Advance directives (ADs) are legal documents that outline a person's preferences or decisions regarding end-of-life care ahead of time. In Korea, there is insufficient awareness and knowledge about ADs among patients undergoing hemodialysis. This study explored the relationship between perceptions of a good death, knowledge about ADs, and attitudes toward ADs in this patient population. Methods: This cross-sectional survey enrolled 119 hemodialysis patients from a secondary hospital in 2021. The participants completed a self-administered questionnaire, and the data were analyzed using the t-test, analysis of variance, Pearson correlation coefficients, Spearman rank correlation coefficients, and multiple regression analysis. Results: The average score for perceptions of a good death among hemodialysis patients was 2.80 out of 4, with clinical symptoms identified as the most critical factor. The average scores for knowledge about ADs and attitudes toward ADs were 5.69 out of 9 and 2.79 out of 4, respectively. There was a positive correlation between perceptions of a good death and attitudes toward ADs (r=0.34, P<0.001), as well as between knowledge about Ads and attitudes toward ADs (r=0.19, P=0.037). Factors influencing attitudes toward Ads included employment status (β=0.22, P=0.011), education level (β=0.22, P=0.013), and perceptions of a good death (β=0.29, P=0.001), which accounted for 24.8% of the variance in attitudes toward ADs. Conclusion: A positive perception of a good death among patients undergoing hemodialysis was associated with a positive attitude toward ADs. Educational programs are needed to improve individuals' understanding of a good death and encourage the development of end-of-life care plans.

Keywords

References

  1. ESRD registry committee, Korean Society of Nephrology. Korean ESRD registry 2019 [Internet]. Seoul: Korean Society of Nephrology; 2019 [cited 2023 Apr 26]. Available from: https://ksn.or.kr/bbs/?code=report_eng. 
  2. ESRD registry committee, Korean Society of Nephrology. End-stage renal disease (ESRD) in Korea in numbers. KSN NEWS 2018;12:4-5. 
  3. Germain MJ, Cohen L. Supportive care for patients with renal disease: time for action. Am J Kidney Dis 2001;38:884-6.  https://doi.org/10.1053/ajkd.2001.28766
  4. Arulkumaran N, Szawarski P, Philips BJ. End of-life care in patients with end-stage renal disease. Nephrol Dial Transplant 2012;27:879-81.  https://doi.org/10.1093/ndt/gfs028
  5. Kim EJ, Lee YJ. Good death awareness, attitudes toward advance directives and preferences for care near the end of life among hospitalized elders in long-term care hospitals. J Korean Acad Fundam Nurs 2019;26:197-209.  https://doi.org/10.7739/jkafn.2019.26.3.197
  6. Cohen LM, Poppel DM, Cohn GM, Reiter GS. A very good death: measuring quality of dying in end-stage renal disease. J Palliat Med 2001;4:167-72.  https://doi.org/10.1089/109662101750290209
  7. Kim SN, Kim HJ. Recognition of good death, attitude towards the withdrawal of life-sustaining treatment, and attitude towards euthanasia in nurses. Korean J Hosp Palliat Care 2016;19:136-44.  https://doi.org/10.14475/kjhpc.2016.19.2.136
  8. Cho YH, Shu SR. Awareness of the good death and attitude toward death among nursing students. AJMAHS 2017;7:597-607.  https://doi.org/10.14257/AJMAHS.2017.01.62
  9. Kim CG. Factors influencing perception of good death among the community-dwelling elderly. Korean J Hosp Palliat Care 2014;17:151-60.  https://doi.org/10.14475/kjhpc.2014.17.3.151
  10. Lee MS, Kim YJ. Good death recognized by the elderly. Jour. of KoCon.a 2013;13:283-99.  https://doi.org/10.5392/JKCA.2013.13.06.283
  11. Hwang YH. Perceived well dying, knowledge and attitude toward advance directives in older patients with chronic heart disease [master's thesis]. Seoul: Hanyang Univ.; 2017. Korean. 
  12. Park SU, Kang YS. The effect of cancer patients' knowledge of advanced directives and perception of good death on attitude toward withdrawal of life-sustaining treatment. JKAIS 2021;22:539-47. 
  13. Lim HS, Yoo JS. Factors affecting on death anxiety in elderly cancer survivors: focusing on ego integrity, depression and awareness of good death. JKAIS 2020;21:197-207. 
  14. National Agency for Management of Life-Sustaining Treatment. Life-sustaining treatment plans [Internet]. Seoul: KoNIBP; c2018 [cited 2023 Apr 26]. Available from: https://www.lst.go.kr/addt/medicalintent.do. 
  15. Jeong EJ. The meaning of life, perception of well dying, and attitudes toward advance directives among older cancer patients [master's thesis]. Busan: Pusan National Univ.; 2018. Korean. 
  16. Nam YH, Seo IS, Lim JH, Choi JH, Kim JE, Cho JH, et al. Application of advance directives for patients with end stage renal disease. Kidney Res Clin Pract 2008;27:85-93. 
  17. Joung SA, Park KY. The relationships between knowledge on advance directive, attitudes towards the withdrawal of life-sustaining treatment and quality of life in hemodialysis patients. J Korean Acad Community Health Nurs 2017;28:291-301.  https://doi.org/10.12799/jkachn.2017.28.3.291
  18. Yeom EY. The influence of good death awareness and knowledge of advance directives on attitude toward advance directives in middle-aged adults. Jour. of KoCon.a 2021;21:676-85. 
  19. Park KR, Jang SH. A correlation study of perception to hospice and knowledge and attitude to advanced directives in adults in a local community. KSIM 2019;7:181-91. 
  20. Jeong ML, Jeong E. Effects of perception on hospice, self-esteem, knowledge on advance directives in nursing student on attitudes toward advance directives. Journal of Digital Convergence 2019;17:255-64. 
  21. Ryu MH. Public knowledge and attitude towards advance directives and their intention towards withdrawing life-sustaining treatment. JKAIS 2022;23:297-307.  https://doi.org/10.5762/KAIS.2022.23.7.297
  22. Perry E, Swartz R, Smith-Wheelock L, Westbrook J, Buck C. Why is it difficult for staff to discuss advance directives with chronic dialysis patients? J Am Soc Nephrol 1996;7:2160-8.  https://doi.org/10.1681/ASN.V7102160
  23. Schwartz CE, Mazor K, Rogers J, Ma Y, Reed G. Validation of a new measure of concept of a good death. J Palliat Med 2003;6:575-84.  https://doi.org/10.1089/109662103768253687
  24. Yoo HI, Yi YH. Middle-aged adults' attitudes toward dignified death and advance directives, and knowledge of advance directives. J Korean Clin Nurs Res 2020;26:86-96. 
  25. Hong SW, Kim SM. Knowledge regarding advance directives among community-dwelling elderly. J Korean Acad Soc Nurs Educ 2013;19: 330-40.  https://doi.org/10.5977/jkasne.2013.19.3.330
  26. Lee HL, Park YH. Attitudes toward advance directives of older adults using senior centers. J Korean Gerontol Nurs 2014;16:160-9.  https://doi.org/10.17079/jkgn.2014.16.2.160
  27. Nolan MT, Bruder M. Patients' attitudes toward advance directives and end-of-life treatment decisions. Nurs Outlook 1997;45:204-8.  https://doi.org/10.1016/S0029-6554(97)90066-X
  28. Cha JE, Yi MS. Symptom clusters and quality of life in patients on hemodialysis. J Korean Clin Nurs Res 2014;20:123-33. 
  29. Kim MS, Gang MH, Kim YO. Completion and related factors of advance directives in old adults. Jour. of KoCon.a 2018;18:240-7. 
  30. Lee HL, Park YH. Attitudes toward advance directives of older adults using senior centers. J Korean Gerontol Nurs 2014;16:160-9.  https://doi.org/10.17079/jkgn.2014.16.2.160