Associated factors for discussing advance directives with family physicians by noncancer outpatients in Japan

Abstract

Background Advance directives (ADs) are seldom discussed between primary care physicians (PCPs) and their patients, especially those with noncancer diseases. The aim was to identify the factors associated with discussing AD by noncancer patients with their physicians. Methods This cross‐sectional study was conducted in a hospital or clinic from October to December 2017. Physicians chose eligible noncancer patients aged 20 years or older to respond to an anonymous self‐completed questionnaire inquiring about the objective variable “I want to discuss AD with my doctor,” as well as basic characteristics, and facilitators and barriers to discussing AD identified in previous studies. The physicians responded to a survey comprising the Palliative Performance Scale (PPS) and inquiring about the disease category for each patient. Data were analyzed using binomial logistic regression analysis. Results A total of 270 patients (valid response rate, 79.6%) were included. Multivariate analysis identified a period of visit to the study site ≥ 3 years (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.05‐4.10), physicians who are very good at taking care of patients’ disease (OR, 12.68; 95% CI, 1.12‐143.22), and patients’ worry about their quality of life (QOL) in the future (OR, 2.69; 95% CI, 1.30‐5.57) as facilitators for discussing AD with physicians, and PPS ≤ 90 (OR, 0.51; 95% CI, 0.26‐0.98) as a barrier. Conclusions Our study indicates that patients’ future QOL concerns, a long period of visit to a hospital, and the presence of physical symptoms were associated with the willingness of noncancer patients to discuss AD with PCPs.

Percepção e Expectativas de Pacientes com Câncer acerca das Diretivas Antecipadas de Vontade

“…No entanto, várias polêmicas ainda permeiam esse assunto, principalmente as relacionadas à falta de Pacientes com Câncer e Diretivas Antecipadas de Vontade conhecimento sobre as DAV, à sua aplicabilidade e ao receio de processo judicial 20,21 . No cenário internacional, os principais obstáculos à aplicabilidade do documento estão relacionados às dificuldades dos pacientes em antecipar e organizar suas vontades, piora da condição de saúde, entre outras, como dificuldade de conversar sobre a morte, mudanças de opiniões e representantes legais que nem sempre são os melhores tradutores dos interesses do paciente [22][23][24] . Apesar das dificuldades, sua utilização é cada vez maior, deslocando-se o foco do debate para seu uso de maneira efetiva 18,25 .…”