Which Factors Have the Greatest Influence on Bereaved Families' Willingness to Execute Advance Directives in Taiwan?

BACKGROUND: Preferences for end-of-life care and attitudes toward executing advance directives (ADs) vary depending on ethical and cultural influences. In traditional Asian family -centered decision making, the family makes important medical decisions. Few studies have examined willingness of Taiwanese to execute ADs. OBJECTIVE: This study aimed to investigate factors associated with willingness of bereaved families of cancer patients in Taiwan to execute ADs. METHODS: Participants were 280 individual family members of deceased cancer patients randomly selected from a cancer registry of an urban medical center in Taiwan. They completed self-reported questionnaires with information about their knowledge of and attitudes toward ADs. RESULTS: Participants showed high willingness (86.4%) to complete ADs . Logistic regression analysis revealed 4 important factors associated with their willingness: (1) participants were primary caregivers (odds ratio [OR], 2.64), (2) willingness to reelect to disclose terminal illness (OR, 4.39), (3) knowledge of the Hospice-Palliative Care Act (HPCA) (OR, 1. 27), and (4) negative perceptions of the HPCA (ie, &quot;cons&quot;) ( OR, 1.07). Advanced analysis revealed that participants with more knowledge of the HPCA had fewer negative perceptions ( = .60; P < .0001). CONCLUSION: Having more knowledge of hospice/palliative care and fewer negative perceptions of HPCA increases willingness to execute ADs for family members or self. IMPLICATIONS FOR PRACTICE: Active promotion of hospice/palliative care and public education about the HPCA provided by medical professionals would contribute to awareness of end-of-life care and knowledge of HPCA, thereby encouraging willingness to complete ADs