Study On The Attitude And Behavior Of Family Members In Setting Up Advance Directives For Stroke Patients

ObjectiveIn China,family members are the main caregivers,spiritual supporters and medical expense payers of patients.Family members play an important role in patients’ medical activities.In this study,family members of stroke patients in a third-level geriatric hospital in Haikou city were selected by convenient sampling method,Using the questionnaire survey to investigate and analyze the current situation of the stroke patients’ families surrogate decision making,family care pressure in stroke patients with disability status,family attitude to end-of-life care preferences and implementing ADs,the attitude of family members’ apoplexy agent decision making preferences for deathbed treatment in stroke patients and to implementing ADs for stroke patients,to analyze the influencing factors of family’s apoplexy agent decision making preferences for deathbed treatment in stroke patients and and the attitude to support stroke patients implementing ADs,to provide directions for the effective implementation of ADs in stroke patients and the improvement of support degree of family members in medical activities of stroke patients.MethodsA cross-sectional survey was conducted in this study.249 stroke patients’ family members who met the inclusion criteria and were hospitalized in a third-level geriatric hospital in Haikou city from November 2018 to January 2019 were selected using the convenient sampling method and investigated by questionnaire survey.In this study,the general information questionnaire was used to investigate the general situation of patients and their family members,the Barthel Index(BI)was used to assess the patients’ ability of daily living activities,The attitude and behavioral intention towards ADs questionnaire was used to investigate the attitudes and current situation of family members towards ADs and related conditions.The attitude and behavioral intention towards ADs questionnaire was adjusted and modified according to the investigation demand based on the questionnaire in domestic and foreign literature.The content validity index and retest reliability of themodified questionnaire were 0.979 and 0.927 respectively.When the patients were given infusion treatment in the morning,the family members were invited to fill in the questionnaire.The investigator explained to the patient’s family the purpose of the study,the time required for the investigation,and their human rights protection measures during the study,and participated in the questionnaire after obtaining their consent.SPSS 22.0 statistical software was used for data analysis and processing in this study.Counting data are described by frequency and composition ratio,the measurement data is described in ? X ? S.Kappa value consistency was used to analyze and evaluate the degree of consistency between family members’ treatment decisions on themselves and patients,as well as their attitude towards ADs on themselves and patients.According to the general data,the degree of family pressure,the present situation of the family members to participate in decision-making,family members’ attitude to ADs implementation condition,the frequency of family members initiate discussions about dying,analyze "results of family members’ agency decision" and "family members’ attitude towards patients to set up ADs" using single factor analysis,and pearson chi-square test was used to find out the possible influencing factors.Multivariate Logistic regression and multivariate stepwise Logistic regression analysis were conducted on the possible influencing factors to obtain the final influencing factors.Results1.Family members’ participation in decision-making accounted for 87.1% of the total number of family members participating in this study,and family members played an important role in the decision-making activities of patients’ hospitalization.2.In terms of the choice of the end-of-life treatment,the family members’ choice of treatment for themselves is not consistent with the choice of treatment for patients(Kappa=0.249,P<0.01).3.A single factor analysis of the decision results of surrogate familiesThe attitude of family members towards “encouraging patients to express their end-of-life treatment wishes” and “respecting the patient’s choice of treatment”,degree of family members’ participation in decision-making,the result of familymembers’ independent decision-making,the family members’ attitude of formulate ADs to patients have an impact on the surrogate decision result of family members(p<0.05;p<0.01).4.Multivariate Logistic regression analysis on the influence of agent decision results of family membersThe attitude of family members towards “encouraging patients to express their end-of-life treatment wishes” is the main factor influencing the results of surrogate decision by family members.Family members who do not care or disagree with "encouraging patients to express their end-of-life treatment wishes" are not likely to choose to respect patients’ own treatment wishes when making surrogate decisions for patients,but to make surrogate decisions on their own or after consulting with other family members.5.A single factor analysis of family members’ attitude towards ADs establishment of patientsThe family members’ hospitalization experience,the proportion of the family members’ payment for the patient’s hospitalization expenses,the family members’ attitude toward "hospice care for patients at the end of life",the family members’ attitude toward "patients’ autonomous decision-making right" and the family members’ attitude toward ADs have an impact on the family members’ attitude toward ADs(p<0.05;p<0.01).6.Multiple stepwise Logistic regression analysis of family members’ attitude towards ADs establishment of patientsHospitalization experience of family members(B=0.198,95%CI= 0.066-0.329,P=0.003)and their attitude towards ADs(B=0.350,95%CI= 0.253-0.448,P=0.000)were protective factors for their attitude towards ADs.Family members’ attitude towards "hospice care for patients at the end of life"(B=-0.058,95%CI=-0.116--0.001,P=0.046)is a risk factor for family members’ attitude towards patients’ establishment of ADs.The above three variables explained 28.7% of the total variation of the family members’ attitude towards patients’ establishment of ADs.ConclusionMost of the family members are opposed to or do not have a clear attitudetowards the patient’s implementation of advance instructions.The law is an important guarantee of the implementation of the ADs.The attitude of family members towards“encouraging patients to express their end-of-life treatment wishes” is the main factor influencing the results of surrogate decision by family members.The main factors that affect the patients’ ADs attitude are whether they have ever been hospitalized,their attitude towards "hospice care for patients at the end of life" and their attitude towards ADs.We should pay more attention to the positive role of family members in patients’ medical activities,to strengthen the education and intervention of patients’ families,to enhance the supporting and guiding role of family members in patients’ medical activities,to promote ACP discussions between patients and their families,to increase the consistency of surrogate decision results with patients’ wishes.