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

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.