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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.
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 | |||
|---|---|---|---|---|---|---|---|---|
| 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 |
| Female | 56 (54.4) | 0.61±0.22 | (.857) | 3.24±0.52 | (.659) | 3.51±0.94 | (.060) | |
| Age† (year) | 30~39a | 10 (9.7) | 0.54±0.18 | 6.30 | 3.02±0.54 | 1.33 | 3.44±0.89 | 0.43 |
| 40~64b | 70 (68.0) | 0.66±0.23 | (.003) | 3.27±0.51 | (.270) | 3.39±0.96 | (.652) | |
| ≥65c | 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 |
| 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 schoola Middle or High schoolb | 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) |
| ≥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 |
| 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 | Poora | 49 (47.6) | 0.59±0.24 | 0.38 | 3.22±0.43 | .027 | 3.03±0.83 | 12.72 |
| Moderateb | 40 (38.8) | 0.64±0.23 | (.686) | 3.20±0.58 | (.973) | 3.43±0.90 | (＜.001) | |
| Wellc | 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) | |||||||
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 | |||
|---|---|---|---|---|---|---|---|---|
| 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 |
| 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 |
| 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 |
| 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) | 2a | 6 (5.8) | 0.67±0.27 | 3.63 | 3.28±0.43 | 0.22 | 3.37±0.73 | 0.09 |
| 3b | 88 (85.4) | 0.58±0.23 | (.030) | 3.20±0.51 | (.803) | 3.35±0.97 | (.991) | |
| 4c | 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 |
| 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 |
| No | 94 (91.3) | 0.60±0.23 | (.332) | 3.24±0.50 | (.091) | 3.41±0.90 | (.031) | |
Table 3.
Participants' Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life (N=103)
Table 4.
Knowledge Level on Advance Medical Directive (N=103)
| Items† | Correct answers |
|---|---|
| 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) |
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