249060 Hospice Decision-Making in Taiwan: The Gap between Knowledge and Practice

Sunday, October 30, 2011

Suchuan Yu , Department of Economics, National Dong Hwa University, Shoufeng, Hualien, Taiwan
Alexander Lin , Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
Po-Wei Chih , Department of Economics, National Dong Hwa University, Shoufeng, Hualien, Taiwan
Cancer has become the top death cause in Taiwan since 1982. Terminal cancer patients experience uncontrollable pains resulting both from cancer itself and relevant medical treatments. To them, curing could mean additional sufferings; to health authorities, an inefficient allocation of limited resources.

By 2009, only 38% of terminal cancer patients chose hospice as end-of-life care even though it has been advocated in Taiwan since 1983. Studies trying to explain the low acceptance normally focused on patients themselves as well as on their knowledge of hospice. Their assumptions are that (1) patients are the decision-makers, and (2) their knowledge of hospice determines whether they will accept it as end-of-life care.

This research points out that: (1) in a Confucius society death is a sensitive issue and hence a taboo which is not openly discussed; (2) important medical decisions quite often are made, not by patients themselves, but by family members; (3) in traditional KAP models, between knowledge (K) and practice (P), there is attitude (A); and having sufficient knowledge does not naturally lead to favorable attitudes.

Using Selection Model/bivariate censored probit, this research resolves the selection bias between knowledge and attitude and ascertains the inter-relationships and -influences between the two. Then, under the assumption that hospice decision is also made by the family members, we apply univariate probit to identify whether it is knowledge or attitude that is a more determining factor on practice of accepting hospice for terminal cancer patients in Taiwan.

Learning Areas:
Diversity and culture
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify having sufficient knowledge does not naturally lead to favorable attitudes for terminal cancer patients in Taiwan and there is a gap between knowledge and practice for hospice decision making.

Keywords: End-of-Life Care, Family Involvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee the aging and public health program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.