A Qualitative Study On Cognition And Promotion Strategies Of Living Wills In Community Residents In Taiyuan

As the aging process accelerates around the world,improving the quality of life has become a goal pursued by people.Living wills,Hospice,palliative care and other concepts gradually came into being.Living wills enable patients to choose whether and what life support treatment to receive according to their personal will at the end of life,help people to achieve a good death,maintain the dignity of patients at the end of life,and also a guarantee for patients’ right to know and autonomy.And living wills as a medical instructions in advance,for the mass popularization of object than to focus on the clinical situation closer to patients and the elderly population,in the medical situation,to promote community of ordinary people is Paramount,the purpose is to make its life support treatment and living wills very professional content have a better cognition,To be cognitively and psychologically prepared to make choices in the future.In this paper,residents in urban villages and urban communities are taken as the research objects to study and explore their cognitive status and acceptance of living wills and other related concepts,and analyze the relevant factors affecting their cognition and acceptance,in order to provide reference for the promotion of living wills in communities.Semi-structured interview was used to interview the research objects,including 25 urban villages and 23 urban residents,respectively.Then NVivo software was used to sort out and analyze the interview data,and the following conclusions were drawn:(1)Residents in urban villages have low participation in living wills,insufficient cognition of life support therapy and living wills,avoidance of end-of-life topics,indulgence of medical decision-making power,and low acceptance of living wills.The interview process is full of frustration,confrontation,defense,dislike and other not smooth situation.The reasons include some of the negative aspects of life and death in Chinese culture,the weak sense of individual autonomy,and the low level of scientific quality of residents in urban villages.(2)Similar to residents in urban villages,residents in urban communities also showed the status quo of topic avoidance of living wills,passive medical decision-making power,weak sense of autonomy,and low acceptance of living wills.The reasons are as follows:the insufficient publicity channels of living wills,the restriction of acceptance of living wills due to the hindrance of traditional filial piety culture,the reduction of autonomy under the control of "patriarchal" mode of doctors and families and the increase of medical insurance reimbursement ratio lead to the breeding of invalid clinical treatment.By comparing the interview results of the two types of community residents,the interview results are basically the same,with only a few differences.The same or similar aspects include the avoidance mentality when facing the topic of death,the autonomy limitation in end-of-life medical decision-making.The differences are as follows: First,the reasons behind the low scientific and cultural quality of the two communities are different:the residents of urban villages generally have low educational level and skip some difficult information selectively;They’re too busy making money to pay attention to living wills and life-support treatments.Some middle-aged and elderly people are not familiar with and immature in using the current developed network social platforms,and they cannot timely capture such information in daily life.Urban community residents generally have better family environment,economic conditions and other aspects,and do not want to pay attention to such a distant and heavy topic with a good life.Lack of relevant channels and opportunities to learn.Second,in living wills on acceptance although is not high,but because of the differences between the two sides have different family conditions: the explanation of urban village community residents family economic conditions generally,think to sign living wills is a luxury thing,his family conditions prompt can not think too much of your own,let nature take its course,specific decisions to the last time as the economic conditions may do.However,some residents in urban communities believe that their family environment is good,the family is harmonious and trusts each other,and their relatives will make decisions according to their own will,and they will not worry about end-of-life treatment due to economic reasons,so they do not consider accepting living wills.Finally,according to the status quo of the living will cognition of the two types of community residents,practical suggestions for the promotion of living wills in communities(including urban villages and urban communities)are proposed.Enrich the cultural connotation of traditional filial piety and strengthen effective family communication;Limiting the "patriarchal" attitude of doctors and families and respecting medical autonomy;Improve the scientific quality of residents and promote the rational choice of living wills;Finally improve hospice care medical insurance,promote the implementation of living wills.