Analysis Of Physician And Nurses’ Knowledge, Attitudes, Preference And Their Influence Factors

ObjectiveTo examine physicians and nurses’ knowledge, preference, attitudes as well as variables that mayimpact on their preference and attitude towards advance directives. Provide a reference for future healthcare and training related to advance directives and provide the basis for promotion of the concept ofadvance directives among the physicians and nurses.MethodsUsing a combination of stratified sampling and random sampling method,300physicians andnurses from3different level hospitals in Zhengzhou were investigated by self-made questionnaire(Including general demographic information, personal values and experiences related to end-of-lifesituation, Advance Directives Knowledge Questionnaire, Advance Medical Directives,Advance DirectivesAttitude Questionnaire) between October2012-April2013.We interviewed them face-to-face to assess theirknowledge, preference, attitude towards advance directives, and used SPSS18.0software package todescribe the variables, and analyze the impacted factors by2test, Kruskal-Wallis Test, binary logisticregression.Results1.300health care workers met the inclusion criteria in this investigation, we got a total of298cases of valid questionnaires, the effective rate was99.3%.2. The average score of Advance Directives Knowledge was (2.73±1.98),34(11.3%) of them allchose not know,74people (24.7%) chose not know more than five questions, only64(21.3%) answeredcorrectly over five questions, indicating a lack of advance directives knowledge. The factors impactadvance directives score were age group and occupation. Among them, the nurse prior knowledge masterythan doctors; the knowledge level of≥36years group is best,≤25age group and the31to35agegroup followed,26to30age group was the worst.3.156(52.3%) in298investigated people were willing to sign an advance directive,51(17.8%)people weren’t,91(29.9%) were unsure. Analyzed the impact factors of advance directives preference using2test, departments,living situation, should participate in medical decisions, view for quality of life,and have ever heard of an advance directive were the impact factors to sign an advance directive.37(12.4%) said their relatives definitely know their end-of-life treatment options, and87(29.2%)said they might know,148(49.7%) said unsure, while26(8.7%) said they certainly not know.248(83.2%)said they were willing to designate a medical care agent, while50(16.8%) who weren’t.173(58.1%) were willing to donate organs or tissues,125(41.9%) weren’t. In173people thatwere willing to donate organs or tissues,73(42.1%) were willing to donate any organs;6(3.5%) werewilling to donate some organs, of which4(2.3%) were willing to donate corneas and only1(0.6%) werewilling to donate corneas and kidneys,1(0.6%) were willing to donate only the heart;16(9.2%) of peoplepreferred their agent to make organ donation decisions for them; and78(45.2%) of people chooseuncertain.In the context of various end-of-life scenarios, in the scenario of coma with a chance to recovery,the treatment refusal rate was lowest (14.3%), intermediate for dementia (47.1%) and persistent vegetativestate (59.5%), and dementia with life-threatening disease got the highest refusal rate (73.9%).4.86.7percent of respondents desired advance directives, determinants of attitudes towardsadvance directives include children, patients’ autonomy, patients’ family views(have met argument offamily for patients’ treatment),fear of increased euthanasia; fear of abuse (patients could be forced to writean advance directives; physician could use a directive as the only basis for a decision without taking intoaccount their own knowledge about the prognosis and the type of illness),individual subjective(feeloverloaded emotionally; talking about advance directives seems insensitive and non-caring), professional’spaternalism (physicians should keep patients alive as long as possible),etc.ConclusionsThis study indicated a serious lack of advance directives knowledge of physicians and nurses,they need systematic and comprehensive training. Most physicians and nurses agreed to sign an advancedirective, and support the clinical application of advance directives. Physicians and nurses’ preference andattitude towards advance directives were affected by many factors, we should take measures to educatephysicians and nurses, patients and their families to prepare for the application of advance directives.