Perception and Attitudes Regarding Living Wills Among Older Adults and Family Caregivers in Rural Areas of Thailand’s Central Region

Abstract

Decision-making regarding end-of-life care remains a challenge for patients and their families, as most patients never plan for their care in advance. This qualitative study aimed to describe the perceptions and attitudes toward living wills among older adults and their family caregivers in a community in a central province of Thailand. Participants were purposively selected according to the following criteria: older adults aged 60 years or above who were able to communicate and respond clearly, and family caregivers aged 18 years or above who lived together with them. Both groups voluntarily provided information through audio-recorded interviews. Data saturation was reached at 15 families, consisting of 15 older adults and 15 caregivers. Data were analyzed using content analysis.

Findings revealed that the perceptions and attitudes of older adults and family caregivers influencing the completion of living will consisted of six key themes: 1) lack of awareness regarding the existence of living wills, particularly in rural communities where information is not widely accessible; 2) beliefs about bad omens or fears that completing a living will may hasten death, especially among those already ill, leading to discouragement, hopelessness, and reluctance to proceed; 3) viewing a living will as irrelevant or unnecessary at the present stage of life, with the belief that they are only needed when being older, seriously ill, or without family support; 4) concerns about neglect in medical care, such as fears of not receiving adequate treatment, not being consulted, and being unable to revise the directive later; 5) absence of real-life examples to confirm the benefits of having a living will, resulting in uncertainty and the need for evidence from lived experiences; and (6) approaches to fostering acceptance of living wills, including providing accurate and easy-to-understand information through communication by healthcare professionals and community-wide dissemination. The study highlights that the promotion the acceptance of living wills should focus on providing clear and easily understandable information, along with communication strategies appropriate to the community context, specifically formulated to reach key target groups, including older adults, families, and village health volunteers.