End-of-life knowledge, attitudes and behaviours associated with hospice care preference in community-dwelling older adults: a cross-sectional survey from Mainland China.

Abstract

To examine end-of-life knowledge, attitudes and behaviours associated with hospice care preference in community-dwelling older adults from Shanghai, China. This was a cross-sectional study recruiting community-dwelling older adults from Shanghai. Bivariate analysis and multivariate logistic regression models were conducted to identify associated factors. Seven community health service centres in Shanghai, China. A total of 404 community-dwelling older adults. Participants were asked to provide their hospice care preference ('If you were to become critically ill with limited life expectancy, would you choose hospice care?') and related reasons. To evaluate knowledge, attitudes and planning behaviours related to end-of-life issues, a structured questionnaire was developed through a multistep process. Demographic and clinical characteristics were also collected. Nearly two-thirds of participants (65.8%) reported awareness of hospice care. Most of the participants (81.2%) reported they would choose hospice care at the end-of-life stage. Bivariate analyses showed that marital status, living status, education background and disposable personal income were significantly associated with hospice care preference. After controlling for confounding variables, the logistic regression analysis suggested the significant effects of knowledge level of hospice care (β=0.318, 95% CI (1.156 to 1.636), p<0.001), truth-telling about terminal prognosis (β=1.005, 95% CI (1.071 to 7.704), p=0.036) and preferred place of death (β=-1.073, 95% CI (0.120 to 0.972), p=0.044) on opting for hospice care. The Chinese older adults' knowledge, attitudes and behaviours towards end-of-life issues in metropolitan areas has been changing. Their preference towards hospice care provides a good foundation for the utilisation of hospice care in the future. Community-based educational interventions should target demographic characteristics such as being unmarried, living alone and having lower levels of education and income among older adults to enhance their knowledge and family communication about hospice care.