Awareness, Knowledge, and Acceptance of Living Wills Among Chinese Cancer Patients: A Cross-Sectional Study

Given the suboptimal quality of end-of-life care among patients with cancer in China, promoting living wills is critical in this population. Living wills ensure that individuals can receive the medical care they desire during the terminal phase of an illness, maintain their dignity, and ultimately achieve a good death. However, current awareness and attitudes about living wills among Chinese patients with cancer remain unclear. We administered a questionnaire survey on living wills to patients with malignant tumors to assess their most important needs and increase understanding about living wills.

In this cross-sectional study using convenience sampling, inpatients with malignant tumors in Wuhan completed our questionnaire between July 2020 and June 2021. We collected patients' sociodemographic characteristics and details regarding their knowledge and attitudes about living wills.

Among 213 patients with malignant tumors, 114 (53.52%) had heard of living wills; 125 (58.69%) expressed their willingness to sign the "Five Wishes" living will document after learning about it through the questionnaire. Patients with malignant tumors had a high level of desire for the following living will items: the lives of family and friends return to normal as soon as possible after their death, maintaining personal hygiene and dignity, and remaining pain-free. The knowledge level of patients with malignant tumors was related to their educational level (p < 0.05) and self-care ability (p < 0.05).

Patients with malignant tumors have a high need for comfort, cleanliness, and pain relief in the terminal stages. Patients with a higher level of education and those with poorer self-care ability had greater knowledge and acceptance of living wills. Promotion can first be targeted toward more highly educated patients and can then be gradually expanded to other groups.