A Study Of Cognitive Attitudes Of The Patients With Malignant Tumor Towards Living Will

ObjectiveThis study aimed to analyze the cognitive attitudes of patients with malignant tumor towards living will through qualitative research,to investigate the factors related to the cognitive attitudes of patients with malignant tumor towards living will on the basis of qualitative research,and to explore the methods and strategies to promote living will among patients with malignant tumor.At the same time,the inner needs of malignant tumor patients at the end stage were analyzed to provide a basis for the direction of clinical care for malignant tumor patients and to improve the survival quality of them at the end stage.Methods(1)Qualitative study.A qualitative study was conducted to analyze the cognitive attitudes of patients with malignant tumor toward living will.An interview outline was prepared,and semi-structured in-depth interviews were conducted on patients with malignant tumor until the results of the interviews reached saturation,and then the data were summarized and analyzed to draw conclusions.(2)Survey research.The questionnaire was developed from the text of "My five wishes" of living will,which is currently promoted in China,and on the basis of it the questions on the perceptions of patients with malignant tumor were added to form the first draft of the questionnaire.The questionnaire was revised and improved by two rounds of expert consultation,and finally formed into A Questionnaire on the Perceived Attitude of Living Will of Oncology Patients.Patients with malignant tumor who were hospitalized in a 3A hospital in Wuhan from July 2020 to December 2020 were randomly selected as the survey subjects by the method of convenience sampling,and one-to-one on-site survey was conducted on patients with malignant tumor using the questionnaire above,and the results of the survey were analyzed by chi-square test and regression analysis using statistical software SPSS22.0.Results(1)A total of 15 patients with malignant tumor were interviewed in the qualitative study,and five main themes were analyzed: The significance of living will as perceived by patients with malignant tumor,acceptance of living will by patients with malignant tumor,understanding and evaluation of the content of living will by patients with malignant tumor,problems in promoting living will,and the main reasons for giving up or not giving up life support treatment at the end of life for patients with malignant tumor.It shows that some patients with malignant tumor think that living will have positive significance for individuals,families and society.Patients with malignant tumor are more sensitive and taboo about the topic of living will,and think family members and younger patients are more difficult to accept it.Patients with malignant tumor have a higher demand for legalized euthanasia and misconceptions about living will.It is more difficult and necessary to promote living will among patients with malignant tumor,and the law is also called for to support the promotion and implementation of living will in China.There are multiple reasons for patients to it.(2)The survey study showed that patients with malignant tumor in general do not have a high degree of cognitive acceptance of living will,and some of them are not willing to cooperate with the studies related to the topic of living will and were not included in the study.A total of 213 patients with malignant tumor were effectively surveyed in the questionnaire survey.The level of awareness of living will among patients with malignant tumor was related to literacy(P < 0.05)and self-care ability(P < 0.05).The percentage of patients who indicated that they were willing to sign living will documents was 58.69%,which was associated with literacy(P < 0.05).Patients with malignant tumor were interested in "I want my family and friends to resume normal life as soon as possible after my death"(85.45%),"I want my bed to be kept dry and clean,and if it is contaminated,please change it as quickly as possible"(67.61%)."I want my body to remain clean and odor-free all the time"(61.50%),and "I don’t want pain and I want to be given enough medication for pain"(65.26%)had higher needs.There was no significant difference in the items chosen by the patients with malignant tumor to fill out the original title of the living will compared to their family members.There was a statistically significant difference in "willingness to talk about dying"(P < 0.05)and "whether to give up life support treatment at the end of life"(P < 0.05).Conclusion(1)Patients with malignant tumor are more sensitive and taboo about the topic of living will,especially young patients and family members of patients with malignant tumor.It is more difficult and necessary to promote advance directives in patients with malignant tumor.(2)The demand for euthanasia policy among patients with malignant tumor is high and the knowledge of living will needs to be deepened.(3)The acceptance of living will among patients with malignant tumor participating in the study was overall higher than that of other groups in the study,and the level of awareness and acceptance of living will among patients with high literacy level was higher than that of patients with low literacy level.(4)Patients with malignant tumor had a higher need for cleanliness and comfort and pain-free at the end of life.(5)Patients with malignant tumor were more able to accept the topic of end-of-life openly than their families.