作者：
Duan-Rung Chen ✉️(陳端容-本所教師), Yuchi Young ✉️, Ashley Shayya, Taylor Perre & Thomas O’Grady
期刊名稱：BMC Palliative Care
發表日期：2025.04.15
發表文章：
摘要/Abstract
跨文化研究揭示台美臨終醫療決策觀念差異：台灣人雖願意由家人代為醫療決策，卻對是否符合自身意願存有疑慮
陳端容老師（國立臺灣大學）與楊毓琪老師（美國紐約州立大學奧本尼分校）團隊，探討文化如何影響人們對臨終醫療決策的想法與做法。研究團隊對348位成年人進行問卷調查（台灣186人、美國162人），並採用年齡配對的方式來確保比較的公平性。結果指出，台灣受訪者在面對重大疾病住院時，較傾向將醫療決策交由家人代為處理（59.1%，高於美國的46.3%）；然而，僅有50.5%的台灣受訪者相信家人能做出符合其個人意願的決定，這一比例顯著低於美國的78.4%。其次，台灣文化中普遍重視家庭共識與孝道觀念，但在「預立醫療指示」的接受度與討論意願方面卻表現出高度開放。這些發現反映出醫療自主與家庭決策間的張力，也凸顯出在台灣推動安寧照護政策時，應加強家庭內部的溝通與預立醫療規劃，以縮小個人意願與實際決策之間的落差。
▶︎ 閱讀完整研究：Chen et al. (2025), BMC Palliative Care, "Cultural interplay in end-of-life care decisions"
Background
Advance directives are essential to advance care planning, allowing individuals to document their end-of-life care preferences in a living, legally binding document. Cultural factors such as collectivism and family values can shape beliefs and preferences toward advance directives.
Aim
This study compared beliefs and preferences toward advance directives between American and Taiwanese adults.
Design
Cross-sectional survey. A multivariate logistic regression was used to quantify the differences between groups.
Setting / Participants
Age 18 + residing in the U.S. (n = 166) and Taiwan (n = 186).
Results
Compared to the Taiwanese sample, the U.S. sample had more males (37% vs. 21%), more individuals with a graduate education (53% vs. 22%), and fewer single/unmarried participants (38.9% vs. 46.4%). In the multivariate logistic regressions, adults in Taiwan were 2.5 times more likely to value the importance of having an advance directive (aOR 2.5; 95% CI 1.27–5.12), 7.75 times more open to end-of-life care discussions (aOR 7.75; 95% CI 2.03–29.50), and 1.7 times more likely to allow family and loved ones make medical treatment and care decisions during hospitalization for a serious illness on their behalf (aOR = 1.73; 95% CI 1.08–2.78) compared to adults in the U.S. However, adults in Taiwan were less confident that their loved ones’ decisions would align with their personal preferences (aOR = 0.28; 95% CI 0.16–0.47).
Conclusions
Adults in Taiwan place significant importance on advance directives and demonstrate a greater propensity to engage in end-of-life discussions. They also appear more willing than adults in the U.S. to delegate healthcare decisions to their loved ones. Paradoxically, however, they express concerns about whether these decisions align with their personal preferences, a discrepancy likely influenced by cultural values of filial piety and collectivism in Taiwan.
