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The Relationships between Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life in Hemodialysis Patients

Article information

Res Community Public Health Nurs. 2017;28(3):291-301
Publication date (electronic) : 2017 September 12
doi : https://doi.org/10.12799/jkachn.2017.28.3.291
Sun-ae Joung1, Kyung-Yeon Park,2
1On Hospital, Busan, Korea
2Department of Nursing, Silla University, Busan, Korea
Corresponding author: Park, Kyung-Yeon Department of Nursing, Silla University, 140 Baegyang-daero, 700beon-gil, Sasang-gu, Busan 46958, Korea. Tel: +82-51-999-5461, Fax: +82-51-999-6241, E-mail: kypark@silla.ac.kr
Received 2017 July 04; Revised 2017 August 10; Accepted 2017 August 24.

Abstract

Abstract

Purpose

This study aims to investigate the relationships between knowledge on advance directive, attitudes towards the withdrawal of life-sustaining treatment and quality of life among hemodialysis patients.

Methods

A descriptive correlational study was conducted with 103 hemodialysis patients. Data were collected using a structured questionnaire from May to September of 2016, and analysed by using descriptive statistics, t-test, ANOVA and Pearson correlation coefficient.

Results

The participants' knowledge level on advance directive was 5.47±2.08 out of 9, the attitudes towards the withdrawal of life-sustaining treatment was 3.22±0.49 out of 5, and the quality of life was 3.35±0.92 out of 6. The knowledge on advance directive was positively correlated with attitudes towards the withdrawal of life-sustaining treatment (r=.21, p=.037) and quality of life (r=.21, p=.036).

Conclusion

According to the results of this study, the level of knowledge on advance directive is preferred to improve the quality of life of hemodialysis patients. It is needed to support and maintain ongoing education opportunities in order to improve the level of knowledge on advance directive among patients undergoing hemodialysis.

Keywords: Hemodialysis; Knowledge; Advance directive; Quality of life

Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life, by Participants' Sociodemographic Characteristics (N=103)

Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life by Participants' Hemodialysis related Characteristics (N=103)

Participants' Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life (N=103)

Knowledge Level on Advance Medical Directive (N=103)

Correlations among Study Variables (N=103)

References

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Copyright © 2017 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Table 1.

Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life, by Participants' Sociodemographic Characteristics (N=103)

Characteristics Categories n (%) Knowledge on advance directive Attitudes towards the withdrawal of life-sustaining treatment Quality of life
M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
Gender Male 47 (45.6) 0.60±0.25 0.18 3.19±0.46 0.44 3.16±0.88 1.90
Female 56 (54.4) 0.61±0.22 (.857) 3.24±0.52 (.659) 3.51±0.94 (.060)
Age† (year) 30~39a 10 (9.7) 0.54±0.18 6.30 3.02±0.54 1.33 3.44±0.89 0.43
40~64b 70 (68.0) 0.66±0.23 (.003) 3.27±0.51 (.270) 3.39±0.96 (.652)
≥65c 23 (22.3) 0.48±0.20 b＞c 3.16±0.37 3.20±0.84
Religion Yes 71 (68.9) 0.63±0.23 -1.33 3.20±0.48 0.68 3.40±0.97 -0.93
No 32 (31.1) 0.56±0.23 (.187) 3.27±0.51 (.496) 3.22±0.80 (.353)
Marital status Single 13 (12.6) 0.59±0.22 0.09 3.09±0.42 0.79 3.26±1.09 2.57
Married 64 (62.1) 0.61±0.23 (.916) 3.26±0.48 (.455) 3.50±0.85 (.082)
Divorce/bereavement 26 (25.2) 0.60±0.24 3.17±0.55 3.03±0.96
Education Elementary schoola Middle or High schoolb 17 (16.5) 70 (68.0) 0.49±0.22 0.62±0.24 3.38 (.038) 3.08±0.49 3.24±0.49 0.85 (.431) 3.27±0.86 3.29±0.94 1.42 (.247)
≥Collegec 16 (15.5) 0.69±0.17 c＞a 3.28±0.51 3.71±0.87
Job Yes 22 (21.4) 0.61±0.25 0.03 3.16±0.48 0.64 3.56±0.82 -1.15
No 81 (78.6) 0.61±0.23 (.977) 3.23±0.50 (.525) 3.30±0.95 (.254)
Monthly income (10,000 won) ＜100 58 (56.3) 0.59±0.23 1.75 3.16±0.46 4.15 3.18±0.91 2.08
100~199 23 (22.3) 0.57±0.24 (.163) 3.09±0.54 (.008) 3.61±0.91 (.108)
200~299 12 (11.7) 0.69±0.20 3.54±0.49 3.48±0.97
≥300 8 (7.8) 0.74±0.23 3.57±0.30 3.81±0.81
No response 2 (1.9)
Perceived health status Poora 49 (47.6) 0.59±0.24 0.38 3.22±0.43 .027 3.03±0.83 12.72
Moderateb 40 (38.8) 0.64±0.23 (.686) 3.20±0.58 (.973) 3.43±0.90 (＜.001)
Wellc 13 (12.6) 0.61±0.18 3.24±0.47 4.33±0.64 c＞a, b
No response 1 (1.0)
Subsidized in medical expenses Oneself 46 (44.7) 0.63±0.22 0.62 3.21±0.55 0.25 3.55±0.93 1.83
Offspring 25 (22.3) 0.57±0.24 (.540) 3.27±0.50 (.783) 3.17±0.79 (.166)
Others 31 (30.1) 0.61±0.25 3.18±0.40 3.22±1.00
No response 1 (1.0)
Type of medical guarantee Health insurance 54 (52.4) 0.62±0.21 0.27 3.28±0.52 2.03 3.54±0.83 2.86
Medical aid 34 (33.0) 0.60±0.25 (.757) 3.20±0.50 (.136) 3.30±0.97 (.062)
Support a health center 12 (11.7) 0.57±0.26 2.97±0.29 2.88±0.94
No response 3 (2.9)
†

M±SD (year)=56.18±11.90.

Table 2.

Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life by Participants' Hemodialysis related Characteristics (N=103)

Characteristics Categories n (%) Knowledge on advance directive Attitudes towards the withdrawal of life-sustaining treatment Quality of life
M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
Duration of hemodialysis† (month) ≤12 12 (11.7) 0.65±0.20 0.40 3.38±0.29 0.95 3.66±0.73 0.54
13~60 31 (30.1) 0.58±0.23 (.751) 3.26±0.62 (.421) 3.30±0.92 (.654)
61~120 18 (17.5) 0.60±0.24 3.20±0.43 3.35±1.08
≥121 39 (37.9) 0.63±0.25 3.13±0.44 3.29±0.91
No response 3 (2.9)
Pre-existing disease Diabetes 28 (27.2) 0.54±0.25 1.67 3.25±0.46 1.49 3.22±0.98 0.44
Hypertension 29 (28.2) 0.68±0.21 (.180) 3.13±0.48 (.221) 3.42±0.84 (.726)
Glomerulonephritis 24 (23.3) 0.60±0.24 3.38±0.55 3.48±0.97
No response 22 (21.4) 0.60±0.21 3.12±0.46 3.28±0.93
Admission Hx of last a year Yes 42 (40.8) 0.63±0.23 0.91 3.28±0.52 1.07 3.28±0.84 -0.64
No 61 (59.2) 0.59±0.23 (.365) 3.17±0.47 (.287) 3.40±0.98 (.524)
Admission Hx at ICU of last a year Yes 12 (11.7) 0.56±0.19 0.68 3.04±0.25 2.27 3.38±0.56 -0.12
No 91 (88.3) 0.61±0.24 (.500) 3.24±0.51 (.032) 3.35±0.96 (.904)
Hx of emergency hemodialysis Yes 13 (12.6) 0.67±0.21 0.99 3.17±0.47 -0.40 3.63±0.85 1.17
No 90 (87.4) 0.60±0.23 (.324) 3.22±0.50 (.689) 3.31±0.93 (.247)
Frequency of hemodialysis (per a week) 2a 6 (5.8) 0.67±0.27 3.63 3.28±0.43 0.22 3.37±0.73 0.09
3b 88 (85.4) 0.58±0.23 (.030) 3.20±0.51 (.803) 3.35±0.97 (.991)
4c 9 (8.7) 0.79±0.13 c＞b 3.30±0.36 3.31±0.62
Registration of kidney transplantation Yes 33 (32.0) 0.67±0.20 1.81 3.23±0.56 0.20 3.56±1.10 1.42
No 70 (68.0) 0.58±0.24 (.073) 3.21±0.46 (.843) 3.25±0.82 (.163)
Wish of kidney transplantation Yes 40 (38.8) 0.66±0.22 2.01 3.26±0.52 0.74 3.40±1.11 0.42
No 63 (61.2) 0.57±0.23 (.047) 3.19±0.47 (.464) 3.32±0.79 (.675)
Hx of kidney transplantation Yes 9 (8.7) 0.68±0.23 0.98 2.95±0.33 -1.71 2.72±1.00 -2.18
No 94 (91.3) 0.60±0.23 (.332) 3.24±0.50 (.091) 3.41±0.90 (.031)
†

M±SD (momth)=106.63±89.57; Hx=history.

Table 3.

Participants' Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life (N=103)

Variables Mean score Total score
M±SD Actual range Possible range M±SD Actual range Possible range
Knowledge on advance directive 0.61±0.23 0.11~0.89 0~1 5.47±2.08 1~8 0~9
Attitudes towards the withdrawal of life-sustaining treatment 3.22±0.49 2.00~4.53 1~5 61.13±9.32 38~86 19~95
Quality of life 3.35±0.92 1.15~5.42 1~6 110.58±30.48 38~179 33~198

Table 4.

Knowledge Level on Advance Medical Directive (N=103)

Items† Correct answers
n(%)
A patient has a right to permit or reject treatment offered 93(90.3)
A patient has a right to permit or reject LST 91(88.3)
AD is supposed to be prepared while one is competent 75(72.8)
Living will is an instruction that one specifies what actions should be taken for their health if they are no longer able to make decisions due to illness or incapacity 81(78.6)
Living will can not be changed or revoked once written 53(51.5)
Health care proxy is the one who are authorized to make care decisions for a person who designates him/her as proxy 54(52.4)
Health care proxy can not be changed or revoked once designated 54(52.4)
A lawyer is needed to complete AD 41(39.8)
Any changes or revocation is possible whenever and wherever 21(20.4)
†

The items keep literal fidelity to the original tool quoted from knowledge about AD questionnaire by Hong & Kim [16]; LST=life-sustaining treatment; AD=advance directives.

Table 5.

Correlations among Study Variables (N=103)

Variable 1 2 3
r (p) r (p) r (p)
1. Quality of life 1
2. Knowledge on advance medical directive .21 (.036) 1
3. Attitudes towards the withdrawal of life-sustaining treatment .15 (.136) .21 (.037) 1