Knowledge and Attitudes Toward Advance Directive among Patients with Chronic Illness and Relatives
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Abstract
The prevalence of non-communicable diseases among early and middle adulthood populations has increased the risk of life-threatening emergencies. Preparing advance directives is essential to reduce patient suffering and ease the caregiving burden. This descriptive study aimed to examine knowledge and attitudes toward advance directives among patients with chronic illness and their relatives. The Knowledge, Attitudes, Practice (KAP) framework, as guided by Singh and Malaviya, was used for the study. Participants were 200 patients with chronic illness and 200 relatives aged 18-59 years who received treatment at a medical outpatient department in a university-affiliated hospital. Data were collected from August 2020 to May 2022 using self-administered questionnaires. Three questionnaires for both patients with chronic illness and their relatives included 1) a personal information questionnaire, 2) the Questionnaire on Knowledge of Advance Directives, and 3) the Questionnaire on Attitudes Toward Advance Directives. The two questionnaires on knowledge and attitudes toward advance directives were developed by researchers and validated by 5 experts with content validity indices of 0.94 and 0.98, respectively. The reliability of knowledge of advance directives among patients with chronic illness and their relatives were assessed using the Kuder-Richardson formula 20 (KR 20),yielding a coefficient of .66 and .62 respectively. Meanwhile, Cronbach’s alpha was used to assess the reliability of attitudes toward advance directives in patients with chronic illness and their relatives, yielding a value of .81 and .77 respectively. Descriptive statistics were used to analyze data by frequency, percentage, average, and standard deviation.
The study found that the average age of patients with chronic illnesses was 41.48 years (SD = 11.22), while the average age of relatives was 39.99 years (SD = 10.24). The majority of participants in both groups were unaware of advance directives and had not received any education on the topic; however, they expressed a strong interest in creating one to ensure a peaceful and reduced suffering. Most participants agreed to refuse life-sustaining treatment for themselves and their loved ones when nearing the end of life, favoring the option to pass away at home. In the knowledge section, patients with chronic illnesses demonstrated moderate knowledge with a mean of 5.99 (SD = 2.24). The most correct answer to the knowledge question among 88% of patients was: when making an advance directive, it should inform your family and healthcare providers of your wishes if hospitalized. The least correct answer to the knowledge question among 31% of patients was: keeping the original advance directive and copies at home to prevent misplacement. In addition, the relatives of patients with chronic illnesses demonstrated a moderate level of knowledge with a mean of 6.22 (SD = 2.16). The most correct answer to the knowledge question among 88.50% of relatives was: when making an advance directive, it should inform your family and healthcare providers of your wishes if hospitalized. Meanwhile,the least correct answer to the knowledge question among 38.00% of relatives was: an advance directive can only be created at a hospital. In the attitude part, both patients with chronic illnesses and their relatives had positive attitudes toward advance directives, 84.50% and 68.00%,respectively. The results of this study can be used to implement nursing planning, including promoting advanced care plans and enhancing the uptake of advance directives.
Keywords: Advance directive, Attitude, Knowledge, Patients with chronic illness, Relatives
Author Contributions:
KP: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising the manuscript
BS: Conceptualization, Method and design, Data analysis, Writing, revising, and editing the manuscript, Corresponding with the Editor-in-Chief
TJ: Conceptualization, Method and design, Conclusion, Recommendation, Revising the manuscript
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในรามาธิบดีพยาบาลสาร ถือเป็นลิขสิทธิ์ของวารสาร หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่หรือเพื่อกระทำการใด ใด จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษรจากรามาธิบดีพยาบาลสารก่อนเท่านั้น
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