The Relationships between Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life in Hemodialysis Patients

Sun-ae Joung; Kyung-Yeon Park

doi:10.12799/jkachn.2017.28.3.291

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Joung and Park: The Relationships between Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life in Hemodialysis Patients

Original Article

J Korean Acad Community Health Nurs 2017;28(3):291-301.

Published online: 12 September 2017

DOI: https://doi.org/10.12799/jkachn.2017.28.3.291

The Relationships between Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life in Hemodialysis Patients

Sun-ae Joung¹, Kyung-Yeon Park²

¹On Hospital, Busan, Korea

²Department of Nursing, Silla University, Busan, Korea

Corresponding author: Park, Kyung-Yeon Department of Nursing, Silla University, 140 Baegyang-daero, 700beon-gil, Sasang-gu, Busan 46958, Korea. Tel: +82-51-999-5461, Fax: +82-51-999-6241, E-mail: kypark@silla.ac.kr

Received 4 July 2017 Revised 10 August 2017 Accepted 24 August 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aims to investigate the relationships between knowledge on advance directive, attitudes towards the withdrawal of life-sustaining treatment and quality of life among hemodialysis patients.

Methods

A descriptive correlational study was conducted with 103 hemodialysis patients. Data were collected using a structured questionnaire from May to September of 2016, and analysed by using descriptive statistics, t-test, ANOVA and Pearson correlation coefficient.

Results

The participants' knowledge level on advance directive was 5.47±2.08 out of 9, the attitudes towards the withdrawal of life-sustaining treatment was 3.22±0.49 out of 5, and the quality of life was 3.35±0.92 out of 6. The knowledge on advance directive was positively correlated with attitudes towards the withdrawal of life-sustaining treatment (r=.21, p=.037) and quality of life (r=.21, p=.036).

Conclusion

According to the results of this study, the level of knowledge on advance directive is preferred to improve the quality of life of hemodialysis patients. It is needed to support and maintain ongoing education opportunities in order to improve the level of knowledge on advance directive among patients undergoing hemodialysis.

Keywords: Hemodialysis, Knowledge, Advance directive, Quality of life

References

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Table 1.

Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life, by Participants' Sociodemographic Characteristics (N=103)

Characteristics	Categories	n (%)	Knowledge on advance directive		Attitudes towards the withdrawal of life-sustaining treatment		Quality of life
Characteristics	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Gender	Male	47 (45.6)	0.60±0.25	0.18	3.19±0.46	0.44	3.16±0.88	1.90
Gender	Female	56 (54.4)	0.61±0.22	(.857)	3.24±0.52	(.659)	3.51±0.94	(.060)
Age^† (year)	30~39^a	10 (9.7)	0.54±0.18	6.30	3.02±0.54	1.33	3.44±0.89	0.43
	40~64^b	70 (68.0)	0.66±0.23	(.003)	3.27±0.51	(.270)	3.39±0.96	(.652)
	≥65^c	23 (22.3)	0.48±0.20	b＞c	3.16±0.37		3.20±0.84
Religion	Yes	71 (68.9)	0.63±0.23	-1.33	3.20±0.48	0.68	3.40±0.97	-0.93
Religion	No	32 (31.1)	0.56±0.23	(.187)	3.27±0.51	(.496)	3.22±0.80	(.353)
Marital status	Single	13 (12.6)	0.59±0.22	0.09	3.09±0.42	0.79	3.26±1.09	2.57
	Married	64 (62.1)	0.61±0.23	(.916)	3.26±0.48	(.455)	3.50±0.85	(.082)
	Divorce/bereavement	26 (25.2)	0.60±0.24		3.17±0.55		3.03±0.96
Education	Elementary school^a Middle or High school^b	17 (16.5) 70 (68.0)	0.49±0.22 0.62±0.24	3.38 (.038)	3.08±0.49 3.24±0.49	0.85 (.431)	3.27±0.86 3.29±0.94	1.42 (.247)
Education	≥Collegec	16 (15.5)	0.69±0.17	c＞a	3.28±0.51		3.71±0.87
Job	Yes	22 (21.4)	0.61±0.25	0.03	3.16±0.48	0.64	3.56±0.82	-1.15
Job	No	81 (78.6)	0.61±0.23	(.977)	3.23±0.50	(.525)	3.30±0.95	(.254)
Monthly income (10,000 won)	＜100	58 (56.3)	0.59±0.23	1.75	3.16±0.46	4.15	3.18±0.91	2.08
	100~199	23 (22.3)	0.57±0.24	(.163)	3.09±0.54	(.008)	3.61±0.91	(.108)
	200~299	12 (11.7)	0.69±0.20		3.54±0.49		3.48±0.97
	≥300	8 (7.8)	0.74±0.23		3.57±0.30		3.81±0.81
	No response	2 (1.9)
Perceived health status	Poor^a	49 (47.6)	0.59±0.24	0.38	3.22±0.43	.027	3.03±0.83	12.72
	Moderate^b	40 (38.8)	0.64±0.23	(.686)	3.20±0.58	(.973)	3.43±0.90	(＜.001)
	Well^c	13 (12.6)	0.61±0.18		3.24±0.47		4.33±0.64	c＞a, b
	No response	1 (1.0)
Subsidized in medical expenses	Oneself	46 (44.7)	0.63±0.22	0.62	3.21±0.55	0.25	3.55±0.93	1.83
	Offspring	25 (22.3)	0.57±0.24	(.540)	3.27±0.50	(.783)	3.17±0.79	(.166)
	Others	31 (30.1)	0.61±0.25		3.18±0.40		3.22±1.00
	No response	1 (1.0)
Type of medical guarantee	Health insurance	54 (52.4)	0.62±0.21	0.27	3.28±0.52	2.03	3.54±0.83	2.86
	Medical aid	34 (33.0)	0.60±0.25	(.757)	3.20±0.50	(.136)	3.30±0.97	(.062)
	Support a health center	12 (11.7)	0.57±0.26		2.97±0.29		2.88±0.94
	No response	3 (2.9)

^† M±SD (year)=56.18±11.90.

Table 2.

Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life by Participants' Hemodialysis related Characteristics (N=103)

Characteristics	Categories	n (%)	Knowledge on advance directive		Attitudes towards the withdrawal of life-sustaining treatment		Quality of life
Characteristics	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Duration of hemodialysis^† (month)	≤12	12 (11.7)	0.65±0.20	0.40	3.38±0.29	0.95	3.66±0.73	0.54
	13~60	31 (30.1)	0.58±0.23	(.751)	3.26±0.62	(.421)	3.30±0.92	(.654)
	61~120	18 (17.5)	0.60±0.24		3.20±0.43		3.35±1.08
	≥121	39 (37.9)	0.63±0.25		3.13±0.44		3.29±0.91
	No response	3 (2.9)
Pre-existing disease	Diabetes	28 (27.2)	0.54±0.25	1.67	3.25±0.46	1.49	3.22±0.98	0.44
	Hypertension	29 (28.2)	0.68±0.21	(.180)	3.13±0.48	(.221)	3.42±0.84	(.726)
	Glomerulonephritis	24 (23.3)	0.60±0.24		3.38±0.55		3.48±0.97
	No response	22 (21.4)	0.60±0.21		3.12±0.46		3.28±0.93
Admission Hx of last a year	Yes	42 (40.8)	0.63±0.23	0.91	3.28±0.52	1.07	3.28±0.84	-0.64
Admission Hx of last a year	No	61 (59.2)	0.59±0.23	(.365)	3.17±0.47	(.287)	3.40±0.98	(.524)
Admission Hx at ICU of last a year	Yes	12 (11.7)	0.56±0.19	0.68	3.04±0.25	2.27	3.38±0.56	-0.12
Admission Hx at ICU of last a year	No	91 (88.3)	0.61±0.24	(.500)	3.24±0.51	(.032)	3.35±0.96	(.904)
Hx of emergency hemodialysis	Yes	13 (12.6)	0.67±0.21	0.99	3.17±0.47	-0.40	3.63±0.85	1.17
Hx of emergency hemodialysis	No	90 (87.4)	0.60±0.23	(.324)	3.22±0.50	(.689)	3.31±0.93	(.247)
Frequency of hemodialysis (per a week)	2^a	6 (5.8)	0.67±0.27	3.63	3.28±0.43	0.22	3.37±0.73	0.09
	3^b	88 (85.4)	0.58±0.23	(.030)	3.20±0.51	(.803)	3.35±0.97	(.991)
	4^c	9 (8.7)	0.79±0.13	c＞b	3.30±0.36		3.31±0.62
Registration of kidney transplantation	Yes	33 (32.0)	0.67±0.20	1.81	3.23±0.56	0.20	3.56±1.10	1.42
	No	70 (68.0)	0.58±0.24	(.073)	3.21±0.46	(.843)	3.25±0.82	(.163)

Wish of kidney transplantation	Yes	40 (38.8)	0.66±0.22	2.01	3.26±0.52	0.74	3.40±1.11	0.42
Wish of kidney transplantation	No	63 (61.2)	0.57±0.23	(.047)	3.19±0.47	(.464)	3.32±0.79	(.675)
Hx of kidney transplantation	Yes	9 (8.7)	0.68±0.23	0.98	2.95±0.33	-1.71	2.72±1.00	-2.18
Hx of kidney transplantation	No	94 (91.3)	0.60±0.23	(.332)	3.24±0.50	(.091)	3.41±0.90	(.031)

^† M±SD (momth)=106.63±89.57; Hx=history.

Table 3.

Participants' Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life (N=103)

Variables	Mean score			Total score
Variables	M±SD	Actual range	Possible range	M±SD	Actual range	Possible range
Knowledge on advance directive	0.61±0.23	0.11~0.89	0~1	5.47±2.08	1~8	0~9
Attitudes towards the withdrawal of life-sustaining treatment	3.22±0.49	2.00~4.53	1~5	61.13±9.32	38~86	19~95
Quality of life	3.35±0.92	1.15~5.42	1~6	110.58±30.48	38~179	33~198

Table 4.

Knowledge Level on Advance Medical Directive (N=103)

Items^†	Correct answers
Items^†	n(%)
A patient has a right to permit or reject treatment offered	93(90.3)
A patient has a right to permit or reject LST	91(88.3)
AD is supposed to be prepared while one is competent	75(72.8)
Living will is an instruction that one specifies what actions should be taken for their health if they are no longer able to make decisions due to illness or incapacity	81(78.6)
Living will can not be changed or revoked once written	53(51.5)
Health care proxy is the one who are authorized to make care decisions for a person who designates him/her as proxy	54(52.4)
Health care proxy can not be changed or revoked once designated	54(52.4)
A lawyer is needed to complete AD	41(39.8)
Any changes or revocation is possible whenever and wherever	21(20.4)

^† The items keep literal fidelity to the original tool quoted from knowledge about AD questionnaire by Hong & Kim [16]; LST=life-sustaining treatment; AD=advance directives.

Table 5.

Correlations among Study Variables (N=103)

Variable	1	2	3
Variable	r (p)	r (p)	r (p)
1. Quality of life	1
2. Knowledge on advance medical directive	.21 (.036)	1
3. Attitudes towards the withdrawal of life-sustaining treatment	.15 (.136)	.21 (.037)	1

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