Advance care planning and end-oflife care preferences in communitydwelling Hong Kong Chinese elders with medical problems and their next of kin: a cross-sectional study

Abstract

Objectives. The present study aimed to determine advance care planning and end-of-life care preferences of community-dwelling Hong Kong elders with medical problems and their next of kin, and to determine the predictors of their preferences. Methods. Community-dwelling Chinese aged ≥65 years who attended one of the six medical and geriatric out-patient clinics or geriatric day hospitals between July 2012 and August 2013 were included, as were their next of kin. Interview was conducted based on a structured questionnaire. Socio-demographic data, comorbidities, functional status measured by the Katz score, self-perceived health status, and life satisfaction were collected. Preferences for end-of-life care and advance care planning were explored using hypothetical scenarios of an advanced illness. Associations between end-of-life care preferences and other variables were determined. Preferences for end-of-life care were compared between the elders and their next of kin. Results. A total of 153 female and 114 male elders (mean age, 79.2 years) and a total of 128 female and 74 male next of kin were included. Respectively for the elders and next of kin, 87.6% and 88.1% agreed to let ‘nature to guide the elder life’; 83.5% and 97% preferred adequate pain control to keep them ‘free of pain’ despite the side-effect of drowsiness; 65.5% and 43.6% preferred not to use cardiopulmonary resuscitation; 64.8% and 45.1% preferred not to use intubation; 74.9% and 53.9% preferred not to use nasogastric tube feeding; 43.5% and 59.4% preferred ‘repeated courses of antibiotics for infection despite no improvement noted’; 91.6% and 87.9% preferred small oral feeding (rather than the use of nasogastric tube); and 75.5% and 65.6% preferred oral medications (rather than non-invasive positive pressure ventilation). For advance care planning, respectively for the elders and next of kin, 58.4% and 71.4% preferred the doctor to discuss advance care planning with both the patient and family members; 7.9% and 15.1% preferred the doctor to discuss with family members only; 21.7% and 7.0% preferred the doctor to discuss with the patient only; and 11.6% and 6.5% preferred to let the doctor to make decisions. There were significant discordance between elders and next of kin in terms of treatment preference in case of short of breath (p=0.004) and all end-of-life care preferences, except for ‘let nature guide one’s life’. Conclusions. There was significant discordance in end-of-life care preferences between elders and their next of kin. In order to deliver end-oflife care in accordance with elder’s values and beliefs, advance care planning should be discussed with them before they become too ill to do so.