Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers
Abstract
:1. Introduction
- How to measure SDM in EOL care for patients with advanced cancers?
- What is the impact of Confucian familism on SDM in EOL care?
- What are other factors that may influence SDM in EOL care?
2. Materials and Methods
2.1. Participants
2.2. Variables
2.2.1. Measuring SDM
- My doctor made clear that a decision needs to be made.
- My doctor wanted to know exactly how I want to be involved in making the decision.
- My doctor told me that there are different options for treating my medical condition.
- My doctor precisely explained the advantages and disadvantages of the treatment options.
- My doctor helped me understand all the information.
- My doctor asked me which treatment option I prefer.
- My doctor and I thoroughly weighed the different treatment options.
- My doctor and I selected a treatment option together.
- My doctor and I reached an agreement on how to proceed.
2.2.2. Measuring Confucian Familism
2.2.3. Other Variables
2.3. Statistical Analysis
3. Results
3.1. Descriptive Statistics of SDM
3.2. Confucian Familism Associated with SDM
3.3. Other Factors Associated with SDM
3.4. Regression Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Tables
Item | Completely Disagree | Strongly Disagree | Somewhat Disagree | Somewhat Agree | Strongly Agree | Completely Agree |
---|---|---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |
1 | 94 (57.32) | 2 (1.22) | 1 (0.61) | 7 (4.27) | 12 (7.32) | 48 (29.27) |
2 | 97 (59.15) | 2 (1.22) | 1(0.61) | 11 (6.71) | 13 (7.93) | 40 (24.39) |
3 | 94 (57.32) | 0 (0.00) | 5(3.05) | 6 (3.66) | 13 (7.93) | 46 (28.05) |
4 | 94 (57.32) | 2 (1.22) | 2 (1.22) | 6 (3.66) | 10 (6.10) | 50 (30.49) |
5 | 94 (57.32) | 2 (1.22) | 2 (1.22) | 6 (3.66) | 12 (7.32) | 48 (29.27) |
6 | 95 (57.93) | 1 (0.61) | 3 (1.83) | 6 (3.66) | 16 (9.76) | 43 (26.22) |
7 | 96 (58.54) | 2 (1.22) | 2 (1.22) | 8 (4.88) | 10 (6.10) | 46 (28.05) |
8 | 100(60.98) | 1 (0.61) | 5 (3.05) | 5 (3.05) | 9 (5.49) | 44 (26.83) |
9 | 82 (50.00) | 1 (0.61) | 2 (1.22) | 4 (2.44) | 11 (6.71) | 64 (39.02) |
Variable | Description | Coefficient |
---|---|---|
Familism | ||
Siblings c | Number of siblings (0, 1, 2, 3, 4, …) | 0.050 * |
Baseline characteristics | ||
Age b | 0 = 44 to 55; 1 = 56 to 65; 2 = 66 to 75; 3 = 76+ | 0.027 * |
Gender a | 0 = male; 1 = female | 0.150 * |
Schooling years b | 0 = 6−; 1 = 7 to 9; 2 = 9+ | 0.250 |
Marital status a | 0 = otherwise; 1 = married | 0.250 |
Residence a | 0 = cities and towns; 1 = country areas | 0.700 |
Household head a | 0 = No; 1 = Yes | 0.144 * |
Monthly income b | 0 = $152−; 1 = $152 to $454; 2 = $454+ | 0.691 |
Personality | ||
Agreeableness c | In a negative description, 1 = Strongly Agree; 2 = Somewhat agree; 3 = Neutral; 4 = Somewhat disagree; 5 = Strongly Disagree In a positive description, 1 = Strongly Agree; 2 = Somewhat agree; 3 = Neutral; 4 = Somewhat disagree; 5 = Strongly Disagree | 0.935 |
Conscientiousness c | 0.684 | |
Extraversion c | 0.036 * | |
Neuroticism c | 0.419 | |
Openness to experiences c | 0.000 * | |
EOL care assessment | ||
Staff approachableness c | 1 = Strongly Dislike; 2 = Somewhat Dislike 3 = Neutral 4 = Somewhat Like 5 = Strongly Like | 0.621 |
Service quality c | 0.095 * | |
Clinician specialty c | 0.291 | |
Service affordability c | 0.400 | |
Service accessibility c | 0.672 | |
QoL | ||
QoL self-evaluated score c | From 1 = Very Bad to 10 = Very Good | 0.244 |
Chi2 | p Value | Degree of Freedom | |
---|---|---|---|
Familism | |||
Number of siblings | 5.96 | 0.015 | 1 |
Baseline characteristics | |||
55–65 years old | 0.34 | 0.557 | 1 |
66–75 years old | 0.58 | 0.447 | 1 |
75+ years old | 0.01 | 0.931 | 1 |
Female | 0.72 | 0.396 | 1 |
Household head | 0.01 | 0.916 | 1 |
Personality | |||
Extraversion | 2.77 | 0.096 | 1 |
Openness to experiences | 0.22 | 0.636 | 1 |
EOL 1 care assessment | |||
Service quality | 0.38 | 0.535 | 1 |
All factors | 1.88 | 0.993 | 9 |
Appendix B. Figures
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Variables | n | % |
---|---|---|
Age (years) | ||
44–55 | 44 | 26.83 |
56–65 | 76 | 46.34 |
66–75 | 36 | 21.95 |
75+ | 8 | 4.88 |
Gender | ||
Male | 114 | 69.51 |
Female | 50 | 30.49 |
Education (schooling years) | ||
Low (6−) | 53 | 32.32 |
Medium (7 to 9) | 73 | 44.51 |
High (9+) | 38 | 23.17 |
Marital status | ||
Married | 153 | 93.29 |
Never married/widowed/divorced | 11 | 6.71 |
Residence | ||
Rural areas | 102 | 62.2 |
Urban cities | 62 | 37.8 |
Household head | ||
Yes | 118 | 71.95 |
No | 46 | 28.05 |
Monthly income 1 | ||
$151− | 67 | 40.85 |
$152 to $454 | 53 | 32.32 |
$454+ | 44 | 26.83 |
Cancer type | ||
Respiratory | 28 | 17.07 |
Digestive | 47 | 28.66 |
Urological | 70 | 42.68 |
Other | 19 | 11.59 |
Cancer stage | ||
3 | 83 | 50.61 |
4 | 81 | 49.39 |
Factors | Model 1 | Model 2 | Model 3 | Model 4 |
---|---|---|---|---|
Number of siblings | 0.83 ** (0.07) | 0.81 ** (0.08) | 0.80 ** (0.07) | 0.78 ** (0.08) |
44–55 years old (base category) | ||||
56–65 years old | 2.95 *** (1.22) | 3.70 *** (1.64) | 3.33 *** (1.42) | 4.26 *** (1.96) |
66–75 years old | 2.28 * (1.14) | 2.13 (1.12) | 2.78 ** (1.43) | 2.57 * (1.40) |
75+ years old | 0.47 (0.53) | 0.41 (0.50) | 0.33 (0.41) | 0.24 (0.32) |
Male (base category) | ||||
Female | 1.12 (0.70) | 1.53 (0.97) | 0.76 (0.50) | 1.04 (0.70) |
Not head of household (base category) | ||||
Head of household | 0.62 (0.40) | 0.62 (0.41) | 0.36 (0.25) | 0.36 (0.26) |
Extraversion | 1.11 (0.14) | 1.10 (0.14) | ||
Openness to experiences | 2.01 *** (0.37) | 2.07 *** (0.39) | ||
Service quality satisfaction | 0.56 ** (0.13) | 0.53 ** (0.13) | ||
n | 164 | 164 | 164 | 164 |
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Yang, Y.; Qu, T.; Yang, J.; Ma, B.; Leng, A. Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers. Int. J. Environ. Res. Public Health 2022, 19, 10071. https://doi.org/10.3390/ijerph191610071
Yang Y, Qu T, Yang J, Ma B, Leng A. Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers. International Journal of Environmental Research and Public Health. 2022; 19(16):10071. https://doi.org/10.3390/ijerph191610071
Chicago/Turabian StyleYang, Yuexi, Tingting Qu, Jinyue Yang, Ben Ma, and Anli Leng. 2022. "Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers" International Journal of Environmental Research and Public Health 19, no. 16: 10071. https://doi.org/10.3390/ijerph191610071