Advance Care Planning in Japan;

Abstract

Background: This study reports a critique of advance care planning (ACP) by primary care physicians (PCP) in the at-home medical-care field in Japan. Methods: A cross-sectional survey was designed from previous research, piloted, revised, and sent out to all PCP during April and May 2019. The target participants were all the total 914 PCP registered online nationwide in Japan. After piloting, there were 28 question items with five Likert scale, plus some open-ended response items, treated by factor analysis to discover the leading essential characteristics of ACP. Results: The mean scores for each of the 28 items ranged from 3.73 to 4.85, and the leading 18 items were analyzed to reveal there were five factors. These were;-1. Trust in the Doctor-Patient Relationship, 2. Building-up Cooperation, 3. Enlightenment and Awareness of ACP, 4. Level up Views on Life and Death among Health Care Providers, and 5. Patient and Family Preparedness for Death. The inter-factor correlation ranged from 0.06 to 0.44, and Cronbach alpha coefficient ranged from 0.74 to 0.95. Findings showed that more PCP, than not, considered the important characteristics to be (a) Experience of bereavement with someone close, p <0.01, (b) Attached home visiting nurse office, p =0.04, and (c) Medical fee point as home care supporting clinic, p =0.02. Conclusion:A total of five factors were statistically discovered to be necessary for ACP in Japan, and a total of three statistically confirmed basic characteristics.

Information Sharing for Collaborative Care of Older Patients with Heart Failure

“…In Japan, the overwhelming majority of patients still receive end-of-life care in hospitals, 23) although with progress being made in establishing a regional comprehensive medical care system, the number of patients with HF receiving end-of-life care at home is increasing. Our survey showed that HVN were actively involved in ACP, consistent with previous findings, 24) and primary care physicians recognized that collaboration with HVN was important to promote ACP. HN and HVN also required information on social resources and cooperation status of medical institutions, and it can be considered that this information was extracted because it is necessary to promote cooperation between facilities for continuation of patients' home care.…”