Jun Miyashita1,2, Ayako Kohno3, Sayaka Shimizu4,5, Motohiro Kashiwazaki6, Noriki Kamihiro6, Kaoru Okawa7, Masami Fujisaki8, Shunichi Fukuhara9,4,10, Yosuke Yamamoto11. 1. Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, 2-1 Toyochikamiyajiro, Shirakawa, Fukushima, 961-0005, Japan. jun-miya@umin.ac.jp. 2. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. jun-miya@umin.ac.jp. 3. Internationalization Promotion Office, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 5. Institute for Health Outcomes & Process Evaluation Research (iHope International), Kyoto, Japan. 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. 9. Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, 2-1 Toyochikamiyajiro, Shirakawa, Fukushima, 961-0005, Japan. 10. Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan. 11. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: Most adult patients are willing to discuss advance care planning before the onset of any illness. There might be differences in preferences for timing when it comes to initiating advance care planning discussions by healthcare providers with patients. OBJECTIVE: To identify healthcare providers' willingness to initiate advance care planning discussions in Japan. DESIGN: A mixed-methods questionnaire comprising three case scenarios based on three different illness trajectories. PARTICIPANTS: The study participants were physicians and nurses employed in four community hospitals in Japan. MAIN MEASURES: Percentages of physicians' and nurses' willingness to initiate advance care planning discussions at four stages of patients' illness trajectory were quantitatively determined, and perceptions on preferred timing were qualitatively identified. KEY RESULTS: From 108 physician and 123 nurse respondents (response rate: 99%), 291 physician and 362 nurse responses about three case scenarios were obtained. Overall, 51.2% of physicians and 65.5% of nurses (p < 0.001) accepted discussion before illness. Less than one-third of physicians considered advance care planning a "wise precaution," while about two-thirds of nurses did. Additionally, more than half of both physicians and nurses preferred to postpone advance care planning until the patient's imminent death. CONCLUSIONS: Physicians are less willing than nurses to begin advance care planning discussions before patients' health has deteriorated though most prefer to wait until the patients are close to death. Healthcare providers' attitudes toward advance care planning will need to be addressed to improve rates of completion in Japan.
BACKGROUND: Most adult patients are willing to discuss advance care planning before the onset of any illness. There might be differences in preferences for timing when it comes to initiating advance care planning discussions by healthcare providers with patients. OBJECTIVE: To identify healthcare providers' willingness to initiate advance care planning discussions in Japan. DESIGN: A mixed-methods questionnaire comprising three case scenarios based on three different illness trajectories. PARTICIPANTS: The study participants were physicians and nurses employed in four community hospitals in Japan. MAIN MEASURES: Percentages of physicians' and nurses' willingness to initiate advance care planning discussions at four stages of patients' illness trajectory were quantitatively determined, and perceptions on preferred timing were qualitatively identified. KEY RESULTS: From 108 physician and 123 nurse respondents (response rate: 99%), 291 physician and 362 nurse responses about three case scenarios were obtained. Overall, 51.2% of physicians and 65.5% of nurses (p < 0.001) accepted discussion before illness. Less than one-third of physicians considered advance care planning a "wise precaution," while about two-thirds of nurses did. Additionally, more than half of both physicians and nurses preferred to postpone advance care planning until the patient's imminent death. CONCLUSIONS: Physicians are less willing than nurses to begin advance care planning discussions before patients' health has deteriorated though most prefer to wait until the patients are close to death. Healthcare providers' attitudes toward advance care planning will need to be addressed to improve rates of completion in Japan.
Authors: John J You; James Downar; Robert A Fowler; François Lamontagne; Irene W Y Ma; Dev Jayaraman; Jennifer Kryworuchko; Patricia H Strachan; Roy Ilan; Aman P Nijjar; John Neary; John Shik; Kevin Brazil; Amen Patel; Kim Wiebe; Martin Albert; Anita Palepu; Elysée Nouvet; Amanda Roze des Ordons; Nishan Sharma; Amane Abdul-Razzak; Xuran Jiang; Andrew Day; Daren K Heyland Journal: JAMA Intern Med Date: 2015-04 Impact factor: 21.873
Authors: Ana A Teixeira; Louise Hanvey; Carolyn Tayler; Doris Barwich; Sharon Baxter; Daren K Heyland Journal: BMJ Support Palliat Care Date: 2013-10-04 Impact factor: 3.568