title: Advance directive and end-of-life care preferences among nursing home residents in Wuhan, China: a cross-sectional study.
abstract: OBJECTIVE
  To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD.
  
  
  METHODS
  Population-based cross-sectional survey.
  
  
  METHODS
  Nursing homes (n = 31) in Wuhan, Mainland Southern China.
  
  
  METHODS
  Cognitively intact nursing home residents (n = 467) older than 60 years.
  
  
  METHODS
  Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences.
  
  
  RESULTS
  Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098).
  
  
  CONCLUSIONS
  Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.
authors: School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors: Ping
authors: P
authors: Ni
authors: School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors: Jing
authors: J
authors: Zhou
authors: School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors: Zhao Xi
authors: ZX
authors: Wang
authors: School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors: Rong
authors: R
authors: Nie
authors: Faculty of Health, University of Technology Sydney, Sydney, Australia.
authors: Jane
authors: J
authors: Phillips
authors: School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: maojing@hust.edu.cn.
authors: Jing
authors: J
authors: Mao
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011795:Surveys and Questionnaires; D013727:Terminal Care
keywords: Chinese; End-of-life care; advance directive; nursing home