Knowledge, Attitudes and Practices of the Advance Medical Directive in a Residential Estate in Singapore

Author:

Tay Matthew1,Chia Sin Eng2,Sng Judy2

Affiliation:

1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore

2. National University of Singapore, Singapore

Abstract

Introduction: This study investigates the knowledge, attitudes and practices of residents in a residential estate in Singapore on the Advance Medical Directive (AMD). Materials and Methods: A community-based cross-sectional study was conducted with residents in the residential estate of Toa Payoh Lorong 6, Singapore. A stratified random sampling was conducted to obtain a representative sample of the estate. Only residents aged 21 years and older were included. An interviewer-administered questionnaire was conducted, and only those who understood the AMD sufficiently were further evaluated on their knowledge, attitudes and practices. Results: A total of 414 residents were enrolled (50.1% response rate). Only 37.9% of the participants knew about the AMD prior to this study. Participants who had a higher knowledge level of AMD, did not wish “for an artificially prolonged life”, “to be kept alive indefinitely on a life-support machine”, wished to “lessen the financial burden of loved ones”, “avoid prolonged suffering” and accepted the “imminence of death” were more willing to sign an AMD. However, “religious beliefs”, “personal ethical views”, “dissuasion by family members” and “unclear terminology in the AMD” discouraged the participants from signing an AMD. After adjusting for significant factors, participants who did not wish “to be kept alive indefinitely on a life-support machine” and accepted the “imminence of death” were found to correlate significantly with the willingness to sign an AMD [Prevalence Rate Ratio (PRR) = 2.050 [1.140-3.685], P = 0.016; PRR = 2.669 [1.449-4.917], P = 0.02, respectively]. Conclusions: There is a need to increase awareness on the AMD. Public education methods can be improved to inform residents on the implications of the AMD. Key words: Decision making, Predictors

Publisher

Academy of Medicine, Singapore

Subject

General Medicine

Reference14 articles.

1. Singapore Statutes Online [Internet]. Singapore: Government of Singapore c2001. Available at: http://statutes.agc.gov.sg/. Accessed 15 May 2009.

2. Emanuel EJ, Weinberg DS, Gonin R, Hummel LR, Emanuel LL. How well is the Patient Self-Determination Act working?: an early assessment. Am J Med 1993;95:619-28.

3. Freer JP, Eubanks M, Parker B, Hershey CO. Advance directives: ambulatory patients’ knowledge and perspectives. Am J Med 2006; 119:1088.e9-13.

4. Akabayashi A, Slingsby BT, Kai I. Perspectives on advance directives in Japanese society: a population-based questionnaire survey. BMC Med Ethics 2003;4:E5.

5. Robinson MK, DeHaven MJ, Koch KA. Patient Self-Determination Act on patient knowledge and behavior. Department of Community Health and Family Medicine, University of Florida, Jacksonville. J Fam Pract 1993;37:363-8.

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