Preferences for life-sustaining treatments in advance decisions: a cross-sectional survey of Taiwanese general public.

IF 3 1区 哲学 Q1 ETHICS
Daniel Fu-Chang Tsai, Yu-Chen Juang, Chun-Tung Kuo, Ping-Hsueh Lee, Duan-Rung Chen
{"title":"Preferences for life-sustaining treatments in advance decisions: a cross-sectional survey of Taiwanese general public.","authors":"Daniel Fu-Chang Tsai, Yu-Chen Juang, Chun-Tung Kuo, Ping-Hsueh Lee, Duan-Rung Chen","doi":"10.1186/s12910-025-01242-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Taiwan passed the Patient Right to Autonomy Act in 2016 and introduced a legal document called advance decision to address dilemmas in making life-sustaining treatment (LST) decisions for incompetent patients. However, the proportion of Taiwanese adults who have completed an advance decision remains low, and public preference trends are unclear.</p><p><strong>Methods: </strong>A cross-sectional telephone survey was conducted among Taiwanese adults using a structured questionnaire to assess preferences regarding five types of LSTs across four hypothetical clinical scenarios (late-stage motor neuron disease, severe dementia, irreversible coma, and terminal cancer). Participants were categorized based on their preference patterns, and factors associated with each subgroup were analyzed.</p><p><strong>Results: </strong>Of the 3188 individuals contacted, 2440 declined to participate, and 748 (24.3%) respondents were successfully interviewed. A total of 747 responses were included in the analysis. Latent class analysis identified four preference subgroups: pro-forgo (more than half of the respondents), neutral, aggressive, and motor-neuron-disease specific. Older age, higher education, and better quality of life were associated with a greater likelihood of belonging to the pro-forgo group, while being male, unmarried, currently not working, or not residing in northern Taiwan were associated with a lower likelihood.</p><p><strong>Conclusions: </strong>Most respondents expressed a consistent preference to forgo LSTs in the hypothetical clinical scenarios. This suggests that the advance decision, implemented in 2019, may align with public needs. However, given the low completion rate and prevalent preference patterns, policymakers should increase efforts to ensure that those in need have access to appropriate resources and consider implementing a tiered signing process.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"83"},"PeriodicalIF":3.0000,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Medical Ethics","FirstCategoryId":"98","ListUrlMain":"https://doi.org/10.1186/s12910-025-01242-0","RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ETHICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Taiwan passed the Patient Right to Autonomy Act in 2016 and introduced a legal document called advance decision to address dilemmas in making life-sustaining treatment (LST) decisions for incompetent patients. However, the proportion of Taiwanese adults who have completed an advance decision remains low, and public preference trends are unclear.

Methods: A cross-sectional telephone survey was conducted among Taiwanese adults using a structured questionnaire to assess preferences regarding five types of LSTs across four hypothetical clinical scenarios (late-stage motor neuron disease, severe dementia, irreversible coma, and terminal cancer). Participants were categorized based on their preference patterns, and factors associated with each subgroup were analyzed.

Results: Of the 3188 individuals contacted, 2440 declined to participate, and 748 (24.3%) respondents were successfully interviewed. A total of 747 responses were included in the analysis. Latent class analysis identified four preference subgroups: pro-forgo (more than half of the respondents), neutral, aggressive, and motor-neuron-disease specific. Older age, higher education, and better quality of life were associated with a greater likelihood of belonging to the pro-forgo group, while being male, unmarried, currently not working, or not residing in northern Taiwan were associated with a lower likelihood.

Conclusions: Most respondents expressed a consistent preference to forgo LSTs in the hypothetical clinical scenarios. This suggests that the advance decision, implemented in 2019, may align with public needs. However, given the low completion rate and prevalent preference patterns, policymakers should increase efforts to ensure that those in need have access to appropriate resources and consider implementing a tiered signing process.

台湾民众对维持生命治疗之偏好:一项横断面调查。
背景:台湾在2016年通过了《患者自主权法》,并引入了一份名为“预先决定”的法律文件,以解决无能力患者在做出维持生命治疗(LST)决定时的困境。然而,台湾成年人已经完成提前决定的比例仍然很低,公众偏好趋势尚不清楚。方法:对台湾成人进行横断面电话调查,采用结构化问卷,评估在四种假设的临床情景(晚期运动神经元疾病、严重痴呆、不可逆昏迷和晚期癌症)中对五种lst的偏好。参与者根据他们的偏好模式进行分类,并分析与每个亚组相关的因素。结果:在联系的3188个人中,有2440人拒绝参与,748人(24.3%)被成功访谈。共有747份回复被纳入分析。潜在类别分析确定了四个偏好亚组:支持放弃(超过一半的应答者),中性,侵袭性和运动神经元疾病特异性。年龄越大、受教育程度越高、生活质量越高的人越有可能成为“放弃派”,而男性、未婚、目前没有工作或没有居住在台湾北部的人则越有可能成为“放弃派”。结论:大多数被调查者在假设的临床场景中表达了一致的放弃lst的偏好。这表明,2019年实施的预先决定可能符合公众需求。然而,鉴于低完成率和普遍的偏好模式,政策制定者应加大努力,确保有需要的人能够获得适当的资源,并考虑实施分层签署过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信