Investigation And Analysis On The Cognitive,attitude And Behavior Intention Of Advanced Directives In Medical Staff,Patients And Caregivers Of Oncology Department

Objectives:To investigate the cognition,attitude and behavior intention of advanced directives in medical staffs,patients and caregivers of oncology department,and to analyze the influencing factors.As well as the attitude and behavior intention of medical staffs and caregivers towards the establishment of AD for patients.To predict the feasibility of implementing of ACP in the oncology department,so as to provide a basis for managers to formulate a comprehensive AD development strategy in the future.Methods:From May to October 2019,an online questionnaire survey was conducted among 145 medical staff in the Cancer Center of a third-class general hospital in Wuhan,Hubei Province by using social demographic questionnaire,self-designed AD attitude and related behavior questionnaire,and AD attitude and related intention questionnaire.The effective recovery rate was 91.72%.A one-to-one on-site questionnaire survey was conducted among 106 patients and 103 caregivers.A total of 100 questionnaires were collected,and the effective recovery rates were 94.3%and 97.1%,respectively.The data were collated and analyzed by SPSS21.0 software,and the general data were described by mean±standard deviation,median and quartile,as well as frequency and percentage.T-test,analysis of variance and chi-square test were used to compare the differences between groups,and paired chi-square test and Pearson correlation test were used to analyze the correlation.Results:(1)60.9%of medical staff have heard of AD,only 3%of patients and 6%of caregivers have heard of AD.The attitude of medical staff was the most positive,followed by patients,and caregivers were relatively conservative,with the total score of AD’s attitude is(63.44±7.55),(58.7±6.89),(56.61±7.62)respectively.Medical staff behavior intention was also the most positive,and 88%of them were willing to establish AD,there were no significant difference between patients(49%)and caregivers(51%).(2)Living style and the situation of medical decision makers are the influencing factors of patients’ AD attitude,and there is no relationship between general data and patients’ AD behavior intention.The AD attitude of caregivers is influenced by age,education level and place of residence,the place of residence is also the AD behavior intention influence.The AD attitude of medical staff was influenced by education level,marital status,hospitalization experience,caregiver experience,death experience and AD awareness,among which AD awareness,bereavement and caregiver experience were the influencing factors of AD behavior intention.(3)The attitude and behavior intention of medical staff towards the establishment of AD for patients is very positive,and 98.5%of the medical staff are in favor to support patients establish AD.In aspect of behavior intention,90.98%were willing to help patients set up living wills,and 95.49%were willing to help patients appoint health care proxy.Caregivers have a positive attitude towards the establishment of AD for patients,72.0%of them are supporting patients.But they are conservative about the behavior intention,only 54.0%of them are supporting patients set up living wills,and 51.0%are supporting patients appoint health care proxy.(4)There was a positive correlation between the attitude level of AD of medical staff and caregivers and the attitude level of them supporting patients to establish AD(medical staff:r=0.337,P=0.00;caregivers:r=0.549,P=0.00).However,the consistency between the two kinds of AD behavior intention of them is poor(Kappa=0.203-0.254).Conclusion:(1)The awareness rate of AD among oncology patients and their caregivers are very low,so it is necessary to strengthen the propaganda and popularization of AD in non-medical groups.(2)The attitude and behavior intention of AD of medical staff,patients and caregivers of oncology department are at a positive level as a whole,so it is feasible to carry out ACP in oncology department.(3)The attitude of medical staff was the most positive,followed by patients,caregivers of the last.The three groups all have certain concerns and misunderstandings in the establishment of AD,so it is necessary to strengthen the development of death education and the protection of laws and policies.(4)The influencing factors of attitude and behavior intention of medical staff,patients and caregivers are different,and there are many reasons.So targeted intervention measures should be adopted for different groups of people.(5)Improving the AD attitude level of medical staff and caregivers can improve their attitude to support the patient establishment of AD,but it is not possible to establish the correlation between the AD behavior intention of medical staff and caregivers and their behavior intention of establishing AD to patients.