End-of-Life Care Preference: Examination of Chinese Adults with Children and Those Who Lost Their Only Child

Background: Little is known about the end-of-life (EOL) care preference and its associated factors among community-dwelling adults in Mainland China. This study investigated the EOL care preference and its associated factors among community-dwelling Chinese adults in Shanghai, China. Methods: A cross-sectional survey was conducted in Shanghai, China, from April to June in 2013. A total of 1200 older adults aged 60 years and older and another 200 middle-aged and older adults aged 45 years and older who lost their only child were included in the current study. In the current study, the EOL care preference included three categories: preferred family care, preferred care provided by visiting healthcare professionals, and preferred care in a specialized EOL care institute. Childlessness was coded as lost the only child, had children but not coresiding, and had coresiding children. Mor and Hiris's model of choices of setting at the EOL was used to explore the EOL care preference and its associated factors, including sociodemographic characteristics, support networks, functional characteristics, and healthcare system. Multinomial logistic regressions were used to estimate the factors associated with their EOL care preference. Results: In terms of EOL care preference, adults who lost their only child preferred care provided by a specialized EOL care institute (58.43%), while adults who had children preferred family care at home (46.72% for adults who did not coreside with children and 49.04% for those who did). Results from multinomial logistic regressions showed that adults with higher income, having properties, and having children tended to opt for family care at home. Participants with friends' support preferred EOL care provided by visiting healthcare professionals or specialized EOL care institutions over family care at home. Conclusions: Income, wealth, having children, and having friends' support were significant factors that were associated with the EOL care preference among Chinese adults. Home-based EOL care, professional and individualized hospice, or palliative care provided by institutions need to be developed in China.