{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T02:38:22Z","timestamp":1793500702752,"version":"4.5.0"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["NTUH.108-S4390"],"award-info":[{"award-number":["NTUH.108-S4390"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["NTUH.108-S4390"],"award-info":[{"award-number":["NTUH.108-S4390"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["109-2511-H-002-016-MY3"],"award-info":[{"award-number":["109-2511-H-002-016-MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["109-2511-H-002-016-MY3"],"award-info":[{"award-number":["109-2511-H-002-016-MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["113-2410-H-002-067-SS2"],"award-info":[{"award-number":["113-2410-H-002-067-SS2"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010002","name":"Ministry of Education","doi-asserted-by":"publisher","award":["NTU-114L900401"],"award-info":[{"award-number":["NTU-114L900401"]}],"id":[{"id":"10.13039\/100010002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Ethics"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Taiwan passed the <jats:italic>Patient Right to Autonomy Act<\/jats:italic> in 2016 and introduced a legal document called <jats:italic>advance decision<\/jats:italic> to address dilemmas in making life-sustaining treatment (LST) decisions for incompetent patients. However, the proportion of Taiwanese adults who have completed an <jats:italic>advance decision<\/jats:italic> remains low, and public preference trends are unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A cross-sectional telephone survey was conducted among Taiwanese adults using a structured questionnaire to assess preferences regarding five types of LSTs across four hypothetical clinical scenarios (late-stage motor neuron disease, severe dementia, irreversible coma, and terminal cancer). Participants were categorized based on their preference patterns, and factors associated with each subgroup were analyzed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of the 3188 individuals contacted, 2440 declined to participate, and 748 (24.3%) respondents were successfully interviewed. A total of 747 responses were included in the analysis. Latent class analysis identified four preference subgroups: pro-forgo (more than half of the respondents), neutral, aggressive, and motor-neuron-disease specific. Older age, higher education, and better quality of life were associated with a greater likelihood of belonging to the pro-forgo group, while being male, unmarried, currently not working, or not residing in northern Taiwan were associated with a lower likelihood.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Most respondents expressed a consistent preference to forgo LSTs in the hypothetical clinical scenarios. This suggests that the <jats:italic>advance decision<\/jats:italic>, implemented in 2019, may align with public needs. However, given the low completion rate and prevalent preference patterns, policymakers should increase efforts to ensure that those in need have access to appropriate resources and consider implementing a tiered signing process.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12910-025-01242-0","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T04:20:57Z","timestamp":1751602857000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Preferences for life-sustaining treatments in advance decisions: a cross-sectional survey of Taiwanese general public"],"prefix":"10.1186","volume":"26","author":[{"given":"Daniel Fu-Chang","family":"Tsai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chen","family":"Juang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Tung","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping-Hsueh","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duan-Rung","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"1242_CR1","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.1089\/jpm.2017.0459","volume":"21","author":"JJ Sanders","year":"2018","unstructured":"Sanders JJ, Curtis JR, Tulsky JA. Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact. J Palliat Med. 2018;21:S17\u201327. https:\/\/doi.org\/10.1089\/jpm.2017.0459.","journal-title":"J Palliat Med"},{"key":"1242_CR2","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.jpainsymman.2017.08.025","volume":"55","author":"RL Sudore","year":"2018","unstructured":"Sudore RL, Heyland DK, Lum HD, Rietjens JAC, Korfage IJ, Ritchie CS, et al. Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus. J Pain Symptom Manage. 2018;55:245-55.e8. https:\/\/doi.org\/10.1016\/j.jpainsymman.2017.08.025.","journal-title":"J Pain Symptom Manage"},{"key":"1242_CR3","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1016\/j.jpainsymman.2015.01.012","volume":"49","author":"SM Dy","year":"2015","unstructured":"Dy SM, Kiley KB, Ast K, Lupu D, Norton SA, McMillan SC, et al. Measuring what matters: top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association. J Pain Symptom Manage. 2015;49:773\u201381. https:\/\/doi.org\/10.1016\/j.jpainsymman.2015.01.012.","journal-title":"J Pain Symptom Manage"},{"key":"1242_CR4","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1136\/medethics-2013-101544","volume":"41","author":"MP van Wijmen","year":"2015","unstructured":"van Wijmen MP, Pasman HRW, Widdershoven GA, Onwuteaka-Philipsen BD. Continuing or forgoing treatment at the end of life? Preferences of the general public and people with an advance directive. J Med Ethics. 2015;41:599\u2013606. https:\/\/doi.org\/10.1136\/medethics-2013-101544.","journal-title":"J Med Ethics"},{"key":"1242_CR5","doi-asserted-by":"publisher","first-page":"e0172104","DOI":"10.1371\/journal.pone.0172104","volume":"12","author":"G Clarke","year":"2017","unstructured":"Clarke G, Fistein E, Holland A, Barclay M, Theimann P, Barclay S. Preferences for care towards the end of life when decision-making capacity may be impaired: A large scale cross-sectional survey of public attitudes in Great Britain and the United States. PLoS ONE. 2017;12:e0172104. https:\/\/doi.org\/10.1371\/journal.pone.0172104.","journal-title":"PLoS ONE"},{"key":"1242_CR6","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s12904-020-00546-9","volume":"19","author":"J Hamano","year":"2020","unstructured":"Hamano J, Hanari K, Tamiya N. End-of-life care preferences of the general public and recommendations of healthcare providers: A nationwide survey in Japan. BMC Palliat Care. 2020;19:38. https:\/\/doi.org\/10.1186\/s12904-020-00546-9.","journal-title":"BMC Palliat Care"},{"key":"1242_CR7","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1370\/afm.1227","volume":"9","author":"UK Braun","year":"2011","unstructured":"Braun UK, McCullough LB. Preventing life-sustaining treatment by default. Ann Fam Med. 2011;9:250\u20136. https:\/\/doi.org\/10.1370\/afm.1227.","journal-title":"Ann Fam Med"},{"key":"1242_CR8","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1177\/1049909118792517","volume":"36","author":"JP Lambden","year":"2019","unstructured":"Lambden JP, Chamberlin P, Kozlov E, Lief L, Berlin DA, Pelissier LA, et al. Association of Perceived Futile or Potentially Inappropriate Care With Burnout and Thoughts of Quitting Among Health-Care Providers. Am J Hosp Palliat Care. 2019;36:200\u20136. https:\/\/doi.org\/10.1177\/1049909118792517.","journal-title":"Am J Hosp Palliat Care"},{"key":"1242_CR9","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1111\/j.1468-0009.2010.00596.x","volume":"88","author":"CP Sabatino","year":"2010","unstructured":"Sabatino CP. The evolution of health care advance planning law and policy. Milbank Q. 2010;88:211\u201339. https:\/\/doi.org\/10.1111\/j.1468-0009.2010.00596.x.","journal-title":"Milbank Q"},{"key":"1242_CR10","unstructured":"House SA, Schoo C, Ogilvie WA. Advance Directives. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459133\/. Accessed 17 June 2025."},{"key":"1242_CR11","doi-asserted-by":"crossref","unstructured":"Burt RA. The end of autonomy. Hastings Cent Rep. 2005;Spec No:S9-13.","DOI":"10.1353\/hcr.2005.0089"},{"key":"1242_CR12","unstructured":"Hospice Palliative Care Act [Internet]. 2021. https:\/\/law.moj.gov.tw\/ENG\/LawClass\/LawAll.aspx?pcode=L0020066. Accessed 17 June 2025."},{"key":"1242_CR13","doi-asserted-by":"publisher","first-page":"292","DOI":"10.14475\/kjhpc.2016.19.4.292","volume":"19","author":"SY Cheng","year":"2016","unstructured":"Cheng SY, Chen CY, Chiu TY. Advances of Hospice Palliative Care in Taiwan. J Hosp Palliat Care. 2016;19:292\u20135. https:\/\/doi.org\/10.14475\/kjhpc.2016.19.4.292.","journal-title":"J Hosp Palliat Care."},{"key":"1242_CR14","unstructured":"Patient Right to Autonomy Act [Internet]. 2021. https:\/\/law.moj.gov.tw\/ENG\/LawClass\/LawAll.aspx?pcode=L0020189. Accessed 17 June 2025."},{"key":"1242_CR15","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1080\/074811899200803","volume":"23","author":"KM Coppola","year":"1999","unstructured":"Coppola KM, Bookwala J, Ditto PH, Lockhart LK, Danks JH, Smucker WD. Elderly adults\u2019 preferences for life-sustaining treatments: The role of impairment, prognosis, and pain. Death Stud. 1999;23:617\u201334. https:\/\/doi.org\/10.1080\/074811899200803.","journal-title":"Death Stud"},{"key":"1242_CR16","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1157\/13124127","volume":"40","author":"IM Barrio-Cantalejo","year":"2008","unstructured":"Barrio-Cantalejo IM, G\u00f3mez RMB, Medina MCC, Cabezas MAC, Cruz MEM, Lupi\u00e1\u00f1ez PQ. Validation of the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. Aten Primaria. 2008;40:345\u20139. https:\/\/doi.org\/10.1157\/13124127.","journal-title":"Aten Primaria"},{"key":"1242_CR17","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1111\/j.1547-5069.2003.00033.x","volume":"35","author":"RD Froman","year":"2003","unstructured":"Froman RD, Owen SV. Validation of the Spanish life support preference questionnaire (LSPQ). J Nurs Scholarsh. 2003;35:33\u20136. https:\/\/doi.org\/10.1111\/j.1547-5069.2003.00033.x.","journal-title":"J Nurs Scholarsh."},{"key":"1242_CR18","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/JNR.0000000000000006","volume":"21","author":"LJW Suen","year":"2013","unstructured":"Suen LJW, Lee HH, Morris DL. Life-sustaining treatment: A comparison of the preferences of Taiwanese older adults and their family caregiver. J Nurs Res. 2013;21:261\u20139. https:\/\/doi.org\/10.1097\/JNR.0000000000000006.","journal-title":"J Nurs Res"},{"key":"1242_CR19","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1056\/NEJMsa012528","volume":"346","author":"TR Fried","year":"2002","unstructured":"Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346:1061\u20136. https:\/\/doi.org\/10.1056\/NEJMsa012528.","journal-title":"N Engl J Med"},{"key":"1242_CR20","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1111\/hex.12046","volume":"18","author":"A Sav","year":"2013","unstructured":"Sav A, King MA, Whitty JA, Kendall E, McMillan SS, Kelly F, et al. Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect. 2013;18:312\u201324. https:\/\/doi.org\/10.1111\/hex.12046.","journal-title":"Health Expect"},{"key":"1242_CR21","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1177\/0269216308099244","volume":"23","author":"Y Kwon","year":"2008","unstructured":"Kwon Y, Shin D, Lee J, Heo DS, Hong YS, Kim SY, et al. Impact of perception of socioeconomic burden on advocacy for patient autonomy in end-of-life decision making: a study of societal attitudes. Palliat Med. 2008;23:87\u201394. https:\/\/doi.org\/10.1177\/0269216308099244.","journal-title":"Palliat Med"},{"key":"1242_CR22","doi-asserted-by":"publisher","first-page":"E11","DOI":"10.1186\/1472-6939-7-11","volume":"7","author":"H Miyata","year":"2006","unstructured":"Miyata H, Shiraishi H, Kai I. Survey of the general public\u2019s attitudes toward advance directives in Japan: How to respect patients\u2019 preferences. BMC Med Ethics. 2006;7:E11. https:\/\/doi.org\/10.1186\/1472-6939-7-11.","journal-title":"BMC Med Ethics"},{"key":"1242_CR23","doi-asserted-by":"publisher","first-page":"1472","DOI":"10.1016\/j.healthpol.2015.04.014","volume":"119","author":"LA Kissane","year":"2015","unstructured":"Kissane LA, Ikeda B, Akizuki R, Nozaki S, Yoshimura K, Ikegami N. End-of-life preferences of the general public: Results from a Japanese national survey. Health Policy. 2015;119:1472\u201381. https:\/\/doi.org\/10.1016\/j.healthpol.2015.04.014.","journal-title":"Health Policy."},{"key":"1242_CR24","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1136\/bmjspcare-2012-000205","volume":"2","author":"I Torres-Vigil","year":"2012","unstructured":"Torres-Vigil I, Cohen MZ, de la Rosa A, C\u00e1rdenas-Turanzas M, Burbach BE, Tarleton KW, et al. Food or medicine: ethnic variations in perceptions of advanced cancer patients and their caregivers regarding artificial hydration during the last weeks of life. BMJ Support Palliat Care. 2012;2:276\u20139. https:\/\/doi.org\/10.1136\/bmjspcare-2012-000205.","journal-title":"BMJ Support Palliat Care"},{"key":"1242_CR25","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1056\/NEJM198408093110611","volume":"311","author":"B Lo","year":"1984","unstructured":"Lo B, Dornbrand L. Guiding the hand that feeds. Caring for the demented elderly. N Engl J Med. 1984;311:402\u20134. https:\/\/doi.org\/10.1056\/NEJM198408093110611.","journal-title":"N Engl J Med."},{"key":"1242_CR26","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1001\/archinte.145.1.129","volume":"145","author":"M Siegler","year":"1985","unstructured":"Siegler M, Weisbard AJ. Against the emerging stream. Should fluids and nutritional support be discontinued? Arch Intern Med. 1985;145:129\u201331. https:\/\/doi.org\/10.1001\/archinte.145.1.129.","journal-title":"Arch Intern Med."},{"key":"1242_CR27","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1002\/j.1552-146x.1986.tb02305.x","volume":"16","author":"PG Derr","year":"1986","unstructured":"Derr PG. Why food and fluids can never be denied. Hastings Cent Rep. 1986;16:28\u201330. https:\/\/doi.org\/10.1002\/j.1552-146x.1986.tb02305.x.","journal-title":"Hastings Cent Rep"},{"key":"1242_CR28","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1056\/NEJM200001203420312","volume":"342","author":"MR Gillick","year":"2000","unstructured":"Gillick MR. Rethinking the role of tube feeding in patients with advanced dementia. N Engl J Med. 2000;342:206\u201310. https:\/\/doi.org\/10.1056\/NEJM200001203420312.","journal-title":"N Engl J Med"},{"key":"1242_CR29","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1111\/jgs.12924","volume":"62","author":"American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee","year":"2014","unstructured":"American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. American Geriatrics Society feeding tubes in advanced dementia position statement. J Am Geriatr Soc. 2014;62:1590\u20133. https:\/\/doi.org\/10.1111\/jgs.12924. Epub 2014 Jul 17.","journal-title":"J Am Geriatr Soc."},{"key":"1242_CR30","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.clnu.2018.05.024","volume":"38","author":"D Volkert","year":"2019","unstructured":"Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38:10\u201347. https:\/\/doi.org\/10.1016\/j.clnu.2018.05.024.","journal-title":"Clin Nutr"},{"key":"1242_CR31","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.clnu.2016.02.006","volume":"35","author":"C Druml","year":"2016","unstructured":"Druml C, Ballmer PE, Druml W, Oehmichen F, Shenkin A, Singer P, et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clin Nutr. 2016;35:545\u201356. https:\/\/doi.org\/10.1016\/j.clnu.2016.02.006.","journal-title":"Clin Nutr"},{"key":"1242_CR32","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1136\/bmj.330.7498.1007","volume":"330","author":"SA Murray","year":"2005","unstructured":"Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005;330:1007\u201311. https:\/\/doi.org\/10.1136\/bmj.330.7498.1007.","journal-title":"BMJ"},{"key":"1242_CR33","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1111\/j.1365-2702.2007.02220.x","volume":"17","author":"D Birch","year":"2008","unstructured":"Birch D, Draper J. A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia. J Clin Nurs. 2008;17:1144\u201363. https:\/\/doi.org\/10.1111\/j.1365-2702.2007.02220.x.","journal-title":"J Clin Nurs"},{"key":"1242_CR34","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1016\/j.jamda.2020.04.011","volume":"21","author":"YH Hsu","year":"2020","unstructured":"Hsu YH, Chou MY, Chen HM, Chang WC, Chu CS, Wang YC, et al. The trend of aggressive treatments in end-of-life care for older people with dementia after a policy change in Taiwan. J Am Med Dir Assoc. 2020;21:858\u201363. https:\/\/doi.org\/10.1016\/j.jamda.2020.04.011.","journal-title":"J Am Med Dir Assoc"},{"key":"1242_CR35","doi-asserted-by":"publisher","first-page":"e024662","DOI":"10.1136\/bmjopen-2018-024662","volume":"9","author":"WS Tan","year":"2019","unstructured":"Tan WS, Bajpai R, Ho AHY, Low CK, Carl J. Retrospective cohort analysis of real-life decisions about end-of-life care preferences in a Southeast Asian country. BMJ Open. 2019;9:e024662. https:\/\/doi.org\/10.1136\/bmjopen-2018-024662.","journal-title":"BMJ Open."},{"key":"1242_CR36","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s12904-022-01062-8","volume":"21","author":"DR Chen","year":"2022","unstructured":"Chen DR, Jerng JS, Tsai DFC, Young Y. Gender differences in the intention to withhold life-sustaining treatments involving severe dementia for self and on behalf of parent or spouse. BMC Palliat Care. 2022;21:171. https:\/\/doi.org\/10.1186\/s12904-022-01062-8.","journal-title":"BMC Palliat Care"},{"key":"1242_CR37","doi-asserted-by":"publisher","first-page":"e0116913","DOI":"10.1371\/journal.pone.0116913","volume":"10","author":"CY Huang","year":"2015","unstructured":"Huang CY, Hung YT, Chang CM, Juang SY, Lee CC. The association between individual income and aggressive end-of-life treatment in older cancer decedents in Taiwan. PLoS ONE. 2015;10:e0116913. https:\/\/doi.org\/10.1371\/journal.pone.0116913.","journal-title":"PLoS ONE"},{"key":"1242_CR38","doi-asserted-by":"publisher","first-page":"e73889","DOI":"10.1371\/journal.pone.0073889","volume":"8","author":"TS Chang","year":"2013","unstructured":"Chang TS, Chang CM, Hsu TW, Lin YS, Lai NS, Su YC, et al. The combined effect of individual and neighborhood socioeconomic status on nasopharyngeal cancer survival. PLoS ONE. 2013;8:e73889. https:\/\/doi.org\/10.1371\/journal.pone.0073889.","journal-title":"PLoS ONE"},{"key":"1242_CR39","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1634\/theoncologist.2014-0152","volume":"19","author":"CM Chang","year":"2014","unstructured":"Chang CM, Wu CC, Yin WY, Juang SY, Yu CH, Lee CC. Low socioeconomic status is associated with more aggressive end-of-life care for working-age terminal cancer patients. Oncologist. 2014;19:1241\u20138. https:\/\/doi.org\/10.1634\/theoncologist.2014-0152.","journal-title":"Oncologist"},{"key":"1242_CR40","doi-asserted-by":"publisher","first-page":"e460","DOI":"10.1097\/MD.0000000000000460","volume":"94","author":"TS Chang","year":"2015","unstructured":"Chang TS, Su YC, Lee CC. Determinants for aggressive end-of-life care for oral cancer patients. Medicine (Baltimore). 2015;94:e460. https:\/\/doi.org\/10.1097\/MD.0000000000000460.","journal-title":"Medicine (Baltimore)"},{"key":"1242_CR41","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1093\/geront\/45.5.634","volume":"45","author":"J Kwak","year":"2005","unstructured":"Kwak J, Haley WE. Current research findings on end-of-life decision making among racially or ethnically diverse groups. Gerontologist. 2005;45:634\u201341. https:\/\/doi.org\/10.1093\/geront\/45.5.634.","journal-title":"Gerontologist"},{"key":"1242_CR42","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.tics.2009.06.005","volume":"13","author":"JT Cacioppo","year":"2009","unstructured":"Cacioppo JT, Hawkley LC. Perceived social isolation and cognition. Trends Cogn Sci. 2009;13:447\u201354. https:\/\/doi.org\/10.1016\/j.tics.2009.06.005.","journal-title":"Trends Cogn Sci"},{"key":"1242_CR43","doi-asserted-by":"publisher","first-page":"15142","DOI":"10.1073\/pnas.1514249112","volume":"112","author":"SW Cole","year":"2015","unstructured":"Cole SW, Capitanio JP, Chun K, Arevalo JMG, Ma J, Cacioppo JT. Myeloid differentiation architecture of leukocyte transcriptome dynamics in perceived social isolation. Proc Natl Acad Sci U S A. 2015;112:15142\u20137. https:\/\/doi.org\/10.1073\/pnas.1514249112.","journal-title":"Proc Natl Acad Sci U S A"},{"key":"1242_CR44","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1007\/s00520-002-0397-5","volume":"10","author":"TY Chiu","year":"2002","unstructured":"Chiu TY, Hu WY, Chuang RB, Chen CY. Nutrition and hydration for terminal cancer patients in Taiwan. Support Care Cancer. 2002;10:630\u20136. https:\/\/doi.org\/10.1007\/s00520-002-0397-5.","journal-title":"Support Care Cancer"},{"key":"1242_CR45","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1086\/JCE200011408","volume":"11","author":"RM Gready","year":"2000","unstructured":"Gready RM, Ditto PH, Danks JH, Coppola KM, Lockhart LK, Smucker WD. Actual and perceived stability of preferences for life-sustaining treatment. J Clin Ethics. 2000;11:334\u201346.","journal-title":"J Clin Ethics"},{"key":"1242_CR46","doi-asserted-by":"publisher","first-page":"2125","DOI":"10.1001\/archinte.168.19.2125","volume":"168","author":"MN Wittink","year":"2008","unstructured":"Wittink MN, Morales KH, Meoni LA, Ford DE, Wang NY, Klag MJ, et al. Stability of preferences for end-of-life treatment after 3 years of follow-up: The Johns Hopkins Precursors Study. Arch Intern Med. 2008;168:2125\u201330. https:\/\/doi.org\/10.1001\/archinte.168.19.2125.","journal-title":"Arch Intern Med"},{"key":"1242_CR47","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s11673-012-9417-4","volume":"10","author":"IM Barrio-Cantalejo","year":"2013","unstructured":"Barrio-Cantalejo IM, Sim\u00f3n-Lorda P, Molina-Ruiz A, Herrera-Ramos F, Mart\u00ednez-Cruz E, Bailon-G\u00f3mez RM, et al. Stability over time in the preferences of older persons for life-sustaining treatment. J Bioeth Inq. 2013;10:103\u201314. https:\/\/doi.org\/10.1007\/s11673-012-9417-4.","journal-title":"J Bioeth Inq"},{"key":"1242_CR48","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1001\/jamainternmed.2014.1183","volume":"174","author":"CL Auriemma","year":"2014","unstructured":"Auriemma CL, Nguyen CA, Bronheim R, Kent S, Nadiger S, Pardo D, et al. Stability of end-of-life preferences: a systematic review of the evidence. JAMA Intern Med. 2014;174:1085\u201392. https:\/\/doi.org\/10.1001\/jamainternmed.2014.1183.","journal-title":"JAMA Intern Med"}],"container-title":["BMC Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12910-025-01242-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12910-025-01242-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12910-025-01242-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T04:20:58Z","timestamp":1751602858000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedethics.biomedcentral.com\/articles\/10.1186\/s12910-025-01242-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,4]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1242"],"URL":"https:\/\/doi.org\/10.1186\/s12910-025-01242-0","relation":{},"ISSN":["1472-6939"],"issn-type":[{"value":"1472-6939","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,4]]},"assertion":[{"value":"17 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the phone survey, informed consent was obtained verbally after the interviewer had explained the survey's purpose and confirmed the respondent's age and willingness to participate. No personally identifiable information was included. Ethical approval was granted by the Research Ethics Committee of the Office of National Taiwan University Hospital (No. 201909058RINC, 17 October 2019).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"83"}}