Background
Methods
Participants
Study design
Data collection procedure
Questions about advance directives
Questions about end-of-life care
Sociodemographic and disease variables
Data analysis
Results
Characteristics of study participants
Social and Demographic Characteristics | n(%) |
---|---|
Age,years | |
30–39 | 18 (5.69%) |
40–49 | 20 (6.32%) |
50–59 | 88 (27.84%) |
60–69 | 97 (30.69%) |
70–79 | 72 (22.78%) |
80–89 | 21 (6.64%) |
Sex | |
Male | 110 (34.81%) |
Female | 206 (65.19%) |
Marital status | |
Married | 202 (63.92%) |
Divorced | 50 (15.83%) |
Unmarried | 36 (11.39%) |
Widowed | 28 (8.86%) |
Educational Qualifications | |
Junor middle school or less | 229 (72.47%) |
Senior high school | 63 (19.94%) |
College or more | 24 (7.59%) |
Residence | |
Rural | 260 (82.29%) |
City | 56 (17.21%) |
Type of housing | |
Private housing | 243 (76.9%) |
Retal housing | 22 (6.96%) |
Children’s housing | 51 (16.14%) |
Religious belief | |
None | 234 (74.05%) |
Have | 82 (25.95%) |
Children | |
None | 61 (19.3%) |
Have | 255 (80.7%) |
Type of medical insuranse | |
New rural cooperative medical insurance | 260 (82.28%) |
Medical insurance for non-working urban residents | 37 (11.71%) |
Medical insurance for working urban residents | 19 (6.01%) |
Who will cover your medical expenses? | |
Own | 110 (34.81%) |
Children or spouse | 206 (65.19%) |
Morbid Characteristics | n(%) |
---|---|
Type of brain tumor | |
Glioma | 78 (24.68%) |
WHO I-II | 14 (4.43%) |
WHO III-IV | 64 (20.25%) |
Meningioma | 3 (9.49%) |
Lymphoma | 5 (1.58%) |
Brain Metastases | |
From lung cancer | 102 (32.27%) |
From breast cancer | 113 (35.75%) |
From other cancer | 15 (4.73%) |
Treatment currently receiving | |
Surgery | 26 (8.22%) |
Radiotherapy | 233 (73.74%) |
Medicine | 46 (14.55%) |
Support treatment | 11 (3.49%) |
Duration of illness | |
1 month or less | 81 (25.63%) |
2 months to 6 months | 32 (10.13%) |
7 months to 12 months | 54 (17.08%) |
12 months to 24 months | 90 (28.48%) |
25 months or more | 59 (18.68%) |
Symptoms | |
Headache | 181 (57.27%) |
epilepsy | 21 (6.65%) |
Movement disorders | 78 (24.69%) |
Language disorders | 36 (11.39%) |
KPS scores | |
<50 | 37 (11.71%) |
60–79 | 196 (62.02%) |
>80 | 83 (26.27%) |
Advance directives
Questions | Answers | n% |
---|---|---|
Have you heard of ADs (a written statement of a person’s wishes regarding medical treatment, often including a living will, made to ensure these wishes are carried out should you be unable to communicate them to a doctor)? | Yes | 36 (11.39%) |
No | 280 (88.61%) | |
In the future, if ADs were legal in China and you were in a condition wherein you cannot make your own medical decisions (e.g. in coma or cannot speak), would you like to make an AD? | I would | 206 (65.18%) |
I would not | 110 (34.82%) | |
Reasons for preferring to make an AD | ||
Ensure that the end of my life is comfortable and avoid pain | 93 (45.15%) | |
Avoid burdening my family’s economic condition | 66 (32.03%) | |
Hope my wishes could be respected | 23 (11.17%) | |
Avoid imposing burdens on society | 3 (1.45%) | |
Consider the quality of my life is more important than the length of my life | 19 (9.23%) | |
Religious beliefs | 0 | |
Witnessed the rescue of other people | 2 (0.97%) | |
Reasons for preferring not to make an AD | ||
Family members will decide for me | 15 (13.64%) | |
Let it be | 5 (4.55%) | |
No need to think about it now and my doctor will decide for me | 34 (30.91%) | |
Decision may change | 6 (5.45%) | |
Not familiar with the concept of ADs | 47 (42.73%) | |
Religious beliefs | 3 (2.72%) |
Predictors of preferring to make advance directives
Independent Predictors | OR | 95%CI | p value |
---|---|---|---|
Heard of ADs | |||
Yes | 4.727 | 1.626–13.745 | 0.04* |
No (reference group) | 1 | ||
Current treatment | |||
Surgery | 34.5 | 4.918–242.028 | < 0.001* |
Radiotherapy | 14.223 | 2.985–67.778 | 0.001* |
Medicine | 1.25 | 0.232–6.739 | 0.795 |
Support treatment (reference group) | 1 | ||
KPS scores | |||
< 50 | 2.426 | 0.951–6.190 | 0.064 |
60–79 | 0.954 | 0.560–1.626 | 0.862 |
> 80 (reference group) | 1 | ||
Age in years | |||
30–49 | 4.756 | 1.971–11.476 | 0.001* |
50–69 | 3.424 | 2.031–5.773 | < 0.001* |
70–89 (reference group) | 1 | ||
Sex | |||
Male | 3.224 | 1.861–5.586 | < 0.001* |
Female (reference group) | 1 | ||
Educational qualifications | |||
Junior middle school or less (reference group) | 1 | ||
Senior high school | 0.848 | 0.428–1.503 | 0.572 |
College or beyond | 3.905 | 1.131–13.487 | 0.031* |
Residence | |||
Rural | 0.281 | 0.375–1.330 | 0.281 |
Urban (reference group) | 1 | ||
Children | |||
No children | 3.789 | 1.789–8.028 | 0.001* |
Have children (reference group) | 1 | ||
Type of medical insurance | |||
New rural cooperative medical insurance (reference group) | 1 | ||
Medical insurance for nonworking urban residents | 2.767 | 1.171–6.535 | 0.02* |
Medical insurance for working urban residents | 11.62 | 1.528–88.389 | 0.018* |
Who will cover your medical expenses? | |||
Own | 2.568 | 1.511–4.365 | < 0.001* |
Children or spouse (reference group) | 1 |
End-of-life care
Questions | Answers | n% |
---|---|---|
Would you like the medical staff to discuss your illness and end-of-life arrangements directly with you? | I would | 251 (79.43%) |
I would not | 65 (20.57%) | |
If you were terminally ill (a few weeks before death), would you prefer receiving appropriate palliative care that cannot delay death but gives comfort? | I would | 200 (63.29%) |
I would not | 116 (36.71%) | |
If you were terminally ill (a few weeks before death) and in a critical moment (e.g. cardiac arrest), would you prefer receiving resuscitation (cardiopulmonary resuscitation, electrical defibrillation, endotracheal intubation or tracheotomy)? | I would | 208 (65.82%) |
I would not | 86 (27.21%) | |
Not sure | 22 (6.97%) | |
If you were terminally ill (a few weeks before death) and in a persistent vegetative state (such as brain tumour progression), would you prefer life support (including nutritional support, such as tube feeding or percutaneous endoscopic gastrojejunostomy, broad-spectrum antibiotics, blood transfusions or ventilator-assisted ventilation?) | I would | 131 (41.45%) |
I would not | 160 (50.63%) | |
Not sure | 25 (7.92%) |
Predictors of preferring appropriate palliative care
Independent Predictors | OR | 95%CI | p Value |
---|---|---|---|
Type of brain tumour | |||
Brain primary tumour | 4.242 | 2.220–8.108 | 0.000* |
Brain metastases (reference group) | 1 | ||
Age in years | |||
30–49 | 0.119 | 0.051–0.277 | 0.000* |
50–69 | 0.412 | 0.230–0.740 | 0.003* |
70–89 (reference group) | 1 | ||
Sex | |||
Male | 1.911 | 1.156–3.160 | 0.012* |
Female (reference group) | 1 | ||
Educational qualifications | |||
Junior middle school or less (reference group) | 1 | ||
Senior high school | 0.376 | 0.213–0.665 | 0.001* |
College or more | 0.207 | 0.084–0.506 | 0.001* |
Residence | |||
Rural | 1.054 | 0.577–1.923 | 0.865 |
vUrban (reference group) | 1 | ||
Children | |||
None (reference group) | 1 | ||
Have | 1.955 | 1.056-–3.611 | 0.033* |
Type of medical insurance | |||
New rural cooperative medical insurance | 6.435 | 2.065–20.050 | 0.001* |
Medical insurance for nonworking urban residents | 3.187 | 0.888–11.447 | 0.076 |
Medical insurance for working urban residents (reference group) | 1 | ||
Who will cover your medical expenses? | |||
Self (reference group) | 1 | ||
Children or spouse | 4.131 | 2.531–6.744 | 0.000* |