The Factors Associated with End-of-Life Care Decision for Nursing Home Residents with Dementia---A Longitudinal Study from the Perspectives of Healthcare Proxies

When person’s cognitive function gradually deteriorate, family member must to take the role of healthcare decision surrogate more frequently than other chronic illness disease. Many studies used the hypothetic condition to explore the end-of-life care decision of family surrogate. However, some studies found that the idea of the end-of-life care of family surrogates themselves and preference of person with dementia did not reflect to actual end-of-life decision, except the decision maker’s value, family factor and interaction with health care professionals also play an important role. Therefore, the gap of the decision results of hypothetic situation and actual situation should be further examined. The study is a three-year longitudinal study, combine a comparative descriptive design. The purposes of first year are to explore the factors related healthcare proxies’ preference of life sustaining treatment and hospitalization when they confront with two hypothesis conditions (critical illness and irreversible coma), and to test the influence of proxies choice when giving poor outcome information about the sustaining treatment. The purposes of second and third year will to explore what types of healthcare decisions need to be made and to identify factors associated with their decision and quality of decision-making, as well as to compare the difference of decision results under various situations and various time points (every three month). The study subjects are the residents with dementia (Global Deterioration Scale score of 5-7) and their healthcare proxies. Estimating those 150 dyads of residents with dementia/ their proxies will be recruited, each of stage (moderately severe, severe, and end stage) 50 dyads respectively. Chart review and structural questionnaires will be used to data collection. Questionnaires include resident characteristics, healthcare proxy characteristics, and interaction characteristics (interaction with residents with dementia, family member, and health care professionals). Face to face interview and telephone interview will be conducted. he SPSS software will be used to data analysis; descriptive and inferential statistic method are applied; the main inferential statistic methods include McNemar’s test, paired t test, Generalized estimating equations (GEE ), and multiple regression. The study results will to test and verify prior theory, and to fill up the gap of the theory and practice, as well as to be an evidence base for guiding clinical intervention and health policy decision making.

Project ID:PC10108-0700
External Project ID:NSC101-2314-B182-077-MY3