title: Which factors have the greatest influence on bereaved families' willingness to execute advance directives in Taiwan?
abstract: BACKGROUND
  Preferences for end-of-life care and attitudes toward executing advance directives (ADs) vary depending on ethical and cultural influences. In traditional Asian family-centered decision making, the family makes important medical decisions. Few studies have examined willingness of Taiwanese to execute ADs.
  
  
  OBJECTIVE
  This study aimed to investigate factors associated with willingness of bereaved families of cancer patients in Taiwan to execute ADs.
  
  
  METHODS
  Participants were 280 individual family members of deceased cancer patients randomly selected from a cancer registry of an urban medical center in Taiwan. They completed self-reported questionnaires with information about their knowledge of and attitudes toward ADs.
  
  
  RESULTS
  Participants showed high willingness (86.4%) to complete ADs. Logistic regression analysis revealed 4 important factors associated with their willingness: (1) participants were primary caregivers (odds ratio [OR], 2.64), (2) willingness to reelect to disclose terminal illness (OR, 4.39), (3) knowledge of the Hospice-Palliative Care Act (HPCA) (OR, 1.27), and (4) negative perceptions of the HPCA (ie, "cons") (OR, 1.07). Advanced analysis revealed that participants with more knowledge of the HPCA had fewer negative perceptions (β = .60; P < .0001).
  
  
  CONCLUSIONS
  Having more knowledge of hospice/palliative care and fewer negative perceptions of HPCA increases willingness to execute ADs for family members or self.
  
  
  CONCLUSIONS
  Active promotion of hospice/palliative care and public education about the HPCA provided by medical professionals would contribute to awareness of end-of-life care and knowledge of HPCA, thereby encouraging willingness to complete ADs.
authors.affiliation: School of Nursing, Mackay Medicine, Nursing and Management College, and Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Yang
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
authors.forename: Yi-Fang Yvonne
authors.initials: YF
authors.lastname: Hsiung
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Hu
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000331:legislation & jurisprudence / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care / Q000331:legislation & jurisprudence / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000331:legislation & jurisprudence / Q000523:psychology*; D012042:Registries; D057566:Self Report; D011795:Surveys and Questionnaires; D013624:Taiwan; D055815:Young Adult