The preparedness of Hong Kong medical students towards advance directives and end-of-life issues.

Abstract Objectives: To explore the preparedness of medical students towards advance directives and related end-of-life issues, and to examine background factors such as knowledge, attitudes, and experience concerning advance directives and related end-of-life issues. Methods: In 2007, 448 medical students in years 3 to 5 were surveyed at the Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong. Their knowledge, attitudes, and experiences of advance directives and related end-of-life issues, and their self-perceived preparedness to discuss these matters with patients were evaluated. Results: A total of 220 (49%) of the eligible students responded, of whom 79% supported the use of advance directives. Only 65 (30%) students were certain of what advance directives meant and 198 (90%) students felt that their knowledge of advance directives was inadequate. Also, 197 (90%) students felt unprepared about advance directives and end-of-life issues. Factors associated with positive attitude towards advance directives included religion and knowledge. No factors were found to be associated with self-perceived preparedness towards advance directives or end-of-life issues. Conclusions: Most of the medical students surveyed demonstrated a positive attitude towards advance directives and recognised the importance of advance directives. However, they felt that they were unprepared and lacking in knowledge and experience of advance directives and end-of-life issues. Wider range and more depth of education is needed to better equip medical students for future practice. Key words: Advance directives; Hong Kong; Living wills; Questionnaires; Students, medical (ProQuest: ... denotes formula omitted.) Introduction In general, the concept of advance directives (AD) for health care refers to a statement, usually written, in which a mentally competent individual specifies the form of future health care desired in the event that competence is lacking.1 Legal scholars regard it as an extension of human rights, largely derived from the principles of informed consent and respect for autonomy. The purpose of an AD is to permit the individual to fulfil their goals according to their own value system, and to relieve the family stress. Since the concept of AD in the context of Hong Kong is currently restricted to refusal of life-sustaining treatment, more experience might be required to evaluate whether a wider approach to health care planning is merited in the future.2 From a global perspective, forerunners in the debate on AD include the USA, Canada, and some European nations; to date, all North American states and most Canadian provinces have adopted legislation on AD. While some European states have relatively lower public awareness on AD, some forms of AD are legally recognised in Denmark, the UK, Belgium, France, Spain, Austria, Hungary, and the Netherlands.3 In Australia and New Zealand, AD is now formally recognised under either common law or legislation.3 Singapore has been particularly progressive with AD legislation since 1996.1 It is noteworthy that cultural and religious views impact on decision-making processes in many Asian countries. This can create ambivalence in determining how best to plan future medical care. In Japan, although concerns about AD have arisen in the past decade, a 2003 study of the general population of the preferences and use of AD showed that most participants found it appropriate to express advance health care preferences by word to their family and / or physician, but not by written documentation for cultural reasons. Thus, Japan has no provision for AD or living wills that are legally binding.4 Similarly, in Malaysia, a study of the views of elderly people found that most were receptive to advance care planning and AD, but felt it unnecessary to have formal written documents due to religious beliefs.5 In Hong Kong, it is unsurprising that the issue of AD has been increasingly aired as the community shares multiple health care challenges with its global neighbours, including increased longevity, better education, and shrinking community networks, all of which contribute to the drive for more comprehensive health care planning. …