Exploring Knowledge, Attitude, and Intention towards Advance Care Planning, Advance Directive, and the Patient Self-Determination Act among Hemodialysis Patients

Abstract

Abstract Background: Hemodialysis holds the highest incidence and prevalence rate in Taiwan globally. However, the implementation of advance care planning (ACP), advance directives (AD), and patient self-determination acts (PSDA) remains limited. Our objective was to examine the current status of ACP, AD and PSDA and explore potential opportunities for enhancement. Methods: We developed a novel questionnaire to assess individuals' knowledge, attitudes, and intentions regarding ACP, AD, and PSDA. We also collected baseline characteristics and additional inquiries for correlation analysis to identify potential influencing factors. Student's t-test and Analysis of Variance were employed to assess significance. Results: Initially, a cohort of 241 patients was initially considered for inclusion in this study. Subsequently, 135 patients agreed to participate in the questionnaire study, resulting in 129 valid questionnaires. Among these respondents, 76 were male (59.9%), and 53 were female (41.1%). Only 13.2% had signed AD. A significant portion (85.3%) indicated that they had not discussed their dialysis prognosis with healthcare providers. Additionally, a mere 14% engaged in conversations about life-threatening decisions. Ninety percent believed that healthcare providers had not furnished information about ACP, and only 30% had discussed such choices with their families. The findings revealed that the average standardized score for ACP and AD goals was 84.97, while the attitude towards PSDA received a standardized score of 69.94. The intention score stood at 69.52 in standardized terms. Potential candidates for ACP initiation included individuals aged 50 to 64, possessing at least a college education, being unmarried, and having no history of diabetes. Conclusion Awareness levels concerning ACP, AD, and PSAD remained notably constrained among patients undergoing hemodialysis. Nevertheless, a positive attitude prevailed, and a significant number of patients were open to signing AD. Nephrologists should engage in ACP from the earliest stages, and considering the characteristics mentioned earlier, initiation of the process could be focused on patients aged 50 to 64, with at least a college education, unmarried status, and no history of diabetes.