Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study
Abstract
:1. Introduction
2. The Conceptual Framework of This Study
3. Methods
3.1. Study Design and Recruitment
3.2. Participants
3.3. Data Collection and Measurement
3.3.1. Personal and Sociodemographic Characteristics
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- Basic attributes: age, gender, place of residence.
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- Disease and life experience: participants were asked if they had any diseases, religious and spiritual beliefs (Yes: 1, No: 0).
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- Social support: participants were asked if they could receive support from health professionals, family, or friends (Yes: 1, No: 0).
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- Attitude towards behavior: a scale for beliefs about life and death was used to measure attitude towards the behavior [25]. The scale measures values and attitude towards death. It consists of seven subscales (views on life after death, fear and anxiety for death, death as liberation, avoidance of death, a sense of purpose for life, interest in death, and perceived life expectancy) and 27 items. Participants answered the questions on a seven-point ranging scale. The higher the score, the stronger the belief. Scores for the seven subscales were summed to obtain total scores, which were used in evaluating the characteristics of participants’ beliefs about life and death. Cronbach’s alpha in the present study is 0.751.
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- A sense of behavioral control: two items that the researchers created were used to measure participants’ perceptions of home-based EOLC: whether or not participants thought that home-based EOLC increased the burden of their families and whether or not participants thought that many people in their communities considered home-based EOLC to be natural.
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- Subjective norms: the Japanese version of the Health Locus of Control (LOC) scale was used to develop questions for a sense of behavioral control [26]. The scale effectively reflected Japanese cultural views. Instead of a dichotomous structure of internal and external factors, the Japanese version of the Health LOC Scale consists of 25 question items and the following five subscales: self, family, professionals, coincidence, and supernaturalism. Participants answered the questions on a six-point scale ranging in descending order. The higher the score, the stronger the LOC. Scores for the five subscales were summed to obtain total scores, which were used in evaluating the characteristics of participants’ LOC (Yes: 1, No: 0). Cronbach’s alpha in the present study is 0.678.
3.3.2. Behavioral Intention
3.3.3. Behavioral Outcomes
3.4. Statistical Analysis
3.5. Ethical Consideration
4. Results
4.1. Comparison of the Two Regional Areas
4.2. Relationship between Behavioral Intentions and Behavioral Outcomes (All Participants)
4.3. Personal and Sociodemographic Factors That Affect Behavioral Intention (All Participants)
5. Discussion
5.1. An Overview of Study Participants and a Comparison between Two Regional Areas with Different Death Rates at Home
5.2. Relationship between the Intention to Discuss EOLC and Behavioral Outcome
5.3. Factors That Affect the Intention to Discuss EOLC
5.4. Study Limitations and Significance
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Factor | People Who Did Not Complete the Questionnaire | People Who Completed the Questionnaire | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Hiroshima | Nagi | Hiroshima | Nagi | |||||||||
All | Applicable Participants | All | Applicable Participants | All | Applicable Participants | All | Applicable Participants | |||||
n | n | % | n | n | % | n | n | % | n | n | % | |
Gender: Male | 29 | 8 | 27.6 | 26 | 5 | 19.2 | 82 | 21 | 25.6 | 61 | 15 | 24.6 |
Age: years (mean ± SD) | 29 | 80.8 | ±6.7 | 26 | 82.0 | ±6.8 | 82 | 77.0 | ±5.7 | 61 | 76.0 | ±6.0 |
Experience of life-threatening disease: Yes | 16 | 2 | 12.5 | 19 | 5 | 26.3 | 80 | 24 | 30 | 61 | 16 | 26.2 |
Hiroshima | Nagi | Comparison of Areas | ||||||
Analyzed Participants | Applicable Participants | Analyzed Participants | Applicable Participants | |||||
n | n | % | n | n | % | p-Value | ||
Gender: Male | 82 | 21 | 25.6 | 61 | 15 | 24.6 | 0.889 | a |
Age: years (mean ± SD) | 82 | 77.0 | ±5.7 | 61 | 76.0 | ±6.0 | 0.290 | c |
Behavioral Intention | 80 | 46 | 57.5 | 61 | 36 | 59.0 | 0.856 | a |
Intention to discuss EOLC: Yes | ||||||||
Behavioral outcome | ||||||||
Discussed EOLC with their family: Yes | 80 | 40 | 50.0 | 61 | 27 | 44.3 | 0.723 | a |
Discussed EOLC with family doctor: Yes | 82 | 9 | 11.0 | 60 | 6 | 10.0 | 0.540 | b |
Created a document on EOLC: Yes | 81 | 6 | 7.4 | 59 | 6 | 10.2 | 0.389 | b |
Social Support | ||||||||
Having a family doctor: Yes | 81 | 75 | 92.6 | 61 | 53 | 86.9 | 0.259 | a |
Support by health professionals: Yes | 79 | 22 | 27.8 | 60 | 20 | 33.3 | 0.485 | a |
Support by family: Yes | 82 | 40 | 48.8 | 60 | 30 | 50.0 | 0.886 | a |
Support by friend: Yes | 79 | 30 | 38.0 | 59 | 17 | 28.8 | 0.261 | a |
Experience of life and disease | ||||||||
Experience of a life-threatening disease: Yes | 80 | 24 | 30.0 | 61 | 16 | 26.2 | 0.623 | a |
With an illness undergoing treatment: Yes | 81 | 51 | 63.0 | 60 | 45 | 75.0 | 0.130 | a |
Having religious and spiritual belief: Yes | 81 | 29 | 35.8 | 61 | 16 | 26.2 | 0.225 | a |
Experience in providing EOLC: Yes | 80 | 64 | 80.0 | 60 | 51 | 85.0 | 0.445 | a |
Having media information on EOLC: Yes | 82 | 60 | 73.2 | 61 | 49 | 80.3 | 0.253 | a |
Factor | Hiroshima | Nagi | Comparison of Areas | |||||
All | Applicable Participants | All | Applicable Participants | |||||
n | n | % | n | n | % | p-Value | ||
Attitude towards behavior (Scale for beliefs about life and death): mean ± SD | ||||||||
Views on life after death | 72 | 13.4 | ±5.4 | 54 | 13.1 | ±5.8 | 0.805 | c |
Fear and anxiety for death | 72 | 14.4 | ±5.8 | 54 | 14.7 | ±6.5 | 0.800 | c |
Death as liberation | 72 | 14.8 | ±6.4 | 54 | 14.5 | ±7.2 | 0.769 | c |
Avoidance of death | 72 | 13.3 | ±5.2 | 54 | 13.1 | ±6.4 | 0.840 | c |
A sense of purpose for life | 72 | 15.5 | ±4.6 | 54 | 14.2 | ±6.0 | 0.184 | c |
Interest in death | 72 | 13.9 | ±5.6 | 54 | 14.6 | ±6.1 | 0.525 | c |
Perceived life expectancy | 72 | 12.4 | ±4.6 | 54 | 11.6 | ±5.1 | 0.362 | c |
A sense of behavioral control | ||||||||
Many people in my community recognize home-based EOLC as natural practice: Yes | 77 | 9 | 11.7 | 56 | 12 | 21.4 | 0.152 | b |
Home-based EOLC is burden for my family: Yes | 75 | 42 | 56.0 | 55 | 28 | 50.9 | 0.565 | b |
Subjective norms (LOC score): mean ± SD | ||||||||
Supernaturalism | 77 | 14.6 | ±3.9 | 55 | 13.8 | ±4.3 | 0.329 | c |
Self | 77 | 24.4 | ±3.3 | 55 | 23.8 | ±3.1 | 0.297 | c |
Coincidence | 77 | 16.9 | ±4.1 | 55 | 17.0 | ±5.1 | 0.849 | c |
Family | 77 | 22.4 | ±3.8 | 55 | 22.3 | ±3.3 | 0.771 | c |
Professionals | 77 | 20.0 | ±3.4 | 55 | 19.5 | ±4.4 | 0.429 | c |
Behavior Outcome | Analyzed Participants | Behavior Intention | p-Value | |||||
---|---|---|---|---|---|---|---|---|
Intention to Discuss EOLC | ||||||||
Yes | No | |||||||
n | % | n | % | |||||
Discussed EOLC with their family | 139 | Yes | 60 | 43.2 | 6 | 4.3 | <0.001 | *** |
No | 22 | 15.8 | 51 | 36.7 | ||||
Discussed EOLC with family doctor | 140 | Yes | 14 | 10.0 | 1 | 0.7 | 0.004 | ** |
No | 68 | 48.6 | 57 | 40.7 | ||||
Created a document on EOLC | 138 | Yes | 11 | 8.0 | 1 | 0.7 | 0.015 | * |
No | 70 | 50.7 | 56 | 40.6 |
Factor | B | OR | 95%CI | p-Value | ||
---|---|---|---|---|---|---|
Lower | Upper | |||||
Having a family doctor | 1.660 | 5.259 | 0.717 | 38.568 | 0.103 | |
Having religious and spiritual belief | 1.429 | 4.175 | 1.098 | 15.877 | 0.036 | * |
Experience in providing EOLC | 2.369 | 10.682 | 2.299 | 49.636 | 0.003 | ** |
Having media information on EOLC | 1.882 | 6.567 | 1.593 | 27.074 | 0.009 | ** |
Beliefs about life and death | ||||||
Views on life after death | −0.125 | 0.883 | 0.773 | 1.008 | 0.065 | |
Avoidance of death | −0.191 | 0.526 | 0.728 | 0.938 | 0.003 | ** |
Interest in death | 0.102 | 1.107 | 0.995 | 1.233 | 0.063 | |
LOC | ||||||
Supernaturalism | 0.174 | 1.190 | 0.988 | 1.433 | 0.067 | |
Professionals | −0.150 | 0.861 | 0.719 | 1.233 | 0.102 |
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Ishibashi, T.; Kazawa, K.; Jahan, Y.; Moriyama, M. Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2022, 19, 4273. https://doi.org/10.3390/ijerph19074273
Ishibashi T, Kazawa K, Jahan Y, Moriyama M. Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2022; 19(7):4273. https://doi.org/10.3390/ijerph19074273
Chicago/Turabian StyleIshibashi, Tomoyuki, Kana Kazawa, Yasmin Jahan, and Michiko Moriyama. 2022. "Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study" International Journal of Environmental Research and Public Health 19, no. 7: 4273. https://doi.org/10.3390/ijerph19074273