Associations of health literacy, personality traits, and pro-individualism with the willingness to complete advance directives in Taiwan

• Published in: BMC palliative care Vol. 22; no. 1; pp. 91 - 14
• Main Authors: Chen, Duan-Rung, Weng, Hui-Ching
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.07.2023; BioMed Central; BMC
• Subjects: Access to information; Advance directive; Advance directives; Advance directives (Medicine); Autonomy (Philosophy); Collectivism; Consciousness; Decision making; Evaluation; Health aspects; Health care; Health education; Health literacy; Hospice care; Individualism; Influence; Laws, regulations and rules; Noncognitive factors; Palliative care; Patients; Personal relationships; Personality; Personality traits; Planning; Systematic review; Terminal care; Taiwan; East Asia; United Kingdom > UK; United States > US; Advance directive; Health literacy; Noncognitive factors
• ISSN: 1472-684X; 1472-684X
• DOI: 10.1186/s12904-023-01215-3

Studies indicated that patients with advance directives (ADs) have a generally better quality of life near death. Yet, the concept of ADs is relatively new in East Asian countries. This study examined the associations between health literacy, pro-individualism in end-of-life (EOL) decisions (i.e., EOL pro-individualism), and master-persistence personality traits with the willingness to complete ADs. The data is from a representative data of 1478 respondents from the 2022 Taiwan Social Change Survey. Generalized structural equation modeling (GSEM) was used to conduct path analysis. Nearly half of the respondents (48.7%) were willing to complete ADs. Health literacy has direct and indirect effects through EOL pro-individualism values on the willingness to complete ADs. Noncognitive factors such as mastery-persistence personality traits and EOL pro-individualism values enhanced the willingness to complete ADs. A personalized communication strategy, mindful of personality dimensions and cultural values, can address individual fears and concerns, promoting the benefits of advance care planning (ACP). These influences can provide a roadmap for healthcare providers to customize their approach to ACP discussions, improving patient engagement in AD completion.