Jun Miyashita1,2, Ayako Kohno3, Shao-Yi Cheng4, Su-Hsuan Hsu5, Yosuke Yamamoto2, Sayaka Shimizu2, Wei-Sheng Huang4, Motohiro Kashiwazaki6, Noriki Kamihiro6, Kaoru Okawa7, Masami Fujisaki8, Jaw-Shiun Tsai4, Shunichi Fukuhara1,2. 1. Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan. 2. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3. Department of Health Informatics, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan. 5. Department of Family Medicine, Taipei City Hospital, Taipei, Taiwan. 6. The Kansai Centre for Family Medicine, Kanai Hospital, Kyoto, Japan. 7. Department of Home Care Medicine, Kameda Medical Center, Chiba, Japan. 8. Department of General Medicine, Medical Center Narita Hospital, Chiba, Japan.
Abstract
BACKGROUND: Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain. AIM: To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan. DESIGN: Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing. SETTING/PARTICIPANTS: Patients aged 40-75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited. RESULTS: Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan (p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers' initiative. CONCLUSION: The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients' preferences and factors associated with acceptance and reluctance to initiate advance care planning.
BACKGROUND: Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain. AIM: To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan. DESIGN: Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing. SETTING/PARTICIPANTS: Patients aged 40-75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited. RESULTS: Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan (p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers' initiative. CONCLUSION: The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients' preferences and factors associated with acceptance and reluctance to initiate advance care planning.
Entities:
Keywords:
Advance care planning; Far East; aged; cross-cultural comparison; frailty; middle aged
Authors: Cheng-Pei Lin; Jen-Kuei Peng; Ping-Jen Chen; Hsien-Liang Huang; Su-Hsuan Hsu; Shao-Yi Cheng Journal: Int J Environ Res Public Health Date: 2020-10-29 Impact factor: 3.390