Abstract/References

Association between subjective economic status and refusal of life-prolonging treatment: a cross-sectional study using content analysis with stratified random sampling

Hideaki Kasuga, Shota Endo, Yusuke Masuishi, Tomoo Hidaka, Takeyasu Kakamu, Keiko Saito, Koichi Abe, Tetsuhito Fukushima

Author information
  • Hideaki Kasuga
    Department of Hygiene and Preventive Medicine, Fukushima Medical University
  • Shota Endo
    Department of Hygiene and Preventive Medicine, Fukushima Medical University
  • Yusuke Masuishi
    Department of Hygiene and Preventive Medicine, Fukushima Medical University
  • Tomoo Hidaka
    Department of Hygiene and Preventive Medicine, Fukushima Medical University
  • Takeyasu Kakamu
    Department of Hygiene and Preventive Medicine, Fukushima Medical University
  • Keiko Saito
    Koriyama City Public Health Center
  • Koichi Abe
    Koriyama City Public Health Center
  • Tetsuhito Fukushima
    Department of Hygiene and Preventive Medicine, Fukushima Medical University

Abstract

Introduction: Older adults tend to refuse life-prolonging treatment for various reasons, and it is important to respect their choice of treatment at the end-of-life stage. The present study examines the associations of subjective economic status and gender with reasons for refusal of life-prolonging treatment in older adults in general population.

Methods: In this cross-sectional study, using stratified random sampling, 1,595 older adults living in Koriyama City, Japan, as of 2016, completed self-administered questionnaires on subjective economic status and preference for life-prolonging treatment, with free-description regarding reasons for refusal. We analyzed the associations between the combination of subjective economic status and gender with frequently mentioned terms and their clusters regarding such reasons, using χ2 test, content analysis, text mining and hierarchical cluster analysis.

Results: The combinations of subjective economic status and gender were significantly associated with clustered reasons for refusal of life-prolonging treatment (p < 0.01). The reasons frequently mentioned were: ‘avoidance of unnecessary medical care’ and ‘dignity’ in well-off females; and ‘financial burden on family’ in poor males.

Conclusions: Our findings suggest that older adults who at first glance appear to be freely refusing life-prolonging treatment, may have their decision making restricted through economic constraints.

The content of research paper

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Figures

Table displaying characteristics of a study population, including age, gender, economic status, and preferences for life-prolonging treatment.
Bivariate analysis table showing preferences for life-prolonging treatment based on gender and economic status.
Table displaying various categories and statistics related to health and social issues, including age, disability, and financial stability.
Table displaying associations between subjective economic status and reasons for refusal of LPT, including gender and economic status variables.

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