The Influence of Self-Esteem and Attitudes toward Organ Donation and Euthanasia on Attitudes toward Advance Directives in Married Middle-Aged Adults:A Cross-Sectional Study

Purpose: Preparation for organ donation, euthanasia, and advance directives (AD) during midlife contributes to a dignified end-of-life experience. Self-esteem functions as a key psychological resource in this process. This study aimed to examine self-esteem (SE) and attitudes toward organ donation (ATOD), euthanasia (ATE), and advance directives (ATAD), and to assess their effects on ATAD among married middle-aged adults. Methods: A total of 154 middle-aged adults residing in six community regions across Korea participated in the study. Data were analyzed using SPSS version 23.0, employing descriptive statistics, correlation analysis, and hierarchical regression. Results: SE was positively correlated with ATOD (r=.386, p<.001), ATE (r=.170, p=.035), and ATAD (r=.462, p<.001). ATE was positively correlated with ATOD (r=.402, p<.001), and ATAD was positively correlated with ATOD (r=.677, p<.001) and ATE (r=.384, p<.001). Hierarchical regression analysis demonstrated that ATOD (β=.22, p=.002), being in the 40∼49 age group (β=.19, p=.006), lack of awareness of AD (β=−.18, p=.002), SE (β=.14, p=.016), lower frequency of thinking about organ donation (β=−.13, p=.035), and absence of religion (β=−.10, p=.025) were significant predictors of ATAD. These variables collectively explained 74% of the total variance in ATAD. Conclusion: The findings underscore the need to develop multidisciplinary educational strategies aimed at enhancing key factors that influence ATAD among married middle-aged adults.