Healthcare Providers’ Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study

Miyashita, Jun; Kohno, Ayako; Shimizu, Sayaka; Kashiwazaki, Motohiro; Kamihiro, Noriki; Okawa, K; Fujisaki, Masami; Fukuhara, Shunichi; Yamamoto, Yosuke

doi:10.1007/s11606-020-06524-4

Cited by 12 publications

(7 citation statements)

References 32 publications

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“…In Japan, as a national policy, the government has begun to establish a consultation system for medical treatment and care at the final stage of life to allow individuals to live as humanely as possible [ 9 ]. Although the dialog is important in ACP practice and should begin when the patient can still participate in such discussions, it has become clear that many physicians and nurses in Japan do not want to initiate discussions before the patient’s condition worsens [ 10 ]. Moreover, although the conversation between patients and specialists in the field of palliative care is [ 11 ], the practice of such is reportedly difficult, and few educational programs on ACP practice have been confirmed effective [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an advance care planning training program for practice professionals in Japan incorporating shared decision making skills training: a prospective study of a curricular intervention

et al. 2022

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Background We developed a novel training program for health care professionals that incorporated shared decision making (SDM) skills training into an advance care planning (ACP) training course, the first in Japan. This study aimed to assess the training program’s impact on health care professionals’ knowledge, skill, attitudes, and confidence to initiate ACP. Methods Using the novel Japanese educational program, we evaluated the effect of 8-month programs conducted eight community training sites of professionals who can practice ACP in a local area in Aichi Prefecture (the Aichi ACP Project). SDM skills training was provided during the workshops conducted in the ACP training course, and the participants’ satisfaction and understanding of the training were assessed. After the completion of two workshops, information on SDM skill results from the training and submitted assignments were collected anonymously from the training sites. Result A total of 404 participants completed all education programs. After the first workshop, at least 95% of trainees stated that they were satisfied with the training and that it was useful for ACP practice. The evaluation of the results between the first and second workshops indicated improvement in SDM skills on some items of the SDM measures. In the second workshop, at least 90% of participants submitted implementation reports, and after the second workshop, a survey of confidence in ACP practice was administered, with responses indicating improvement. There were high levels of interest in education related to the ACP practices of oneself and others. Conclusions This educational program can be an effective for developing professionals who can practice ACP with SDM skills.

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Section: Introductionmentioning

confidence: 99%

Evaluation of an advance care planning training program for practice professionals in Japan incorporating shared decision making skills training: a prospective study of a curricular intervention

et al. 2022

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“…This discrepancy might be explained by the fact that the intensity of treatment, such as ICU admission or artificial organ support, is likely lower in elderly patients than in adult patients [ 42 , 43 ]. While medical staffs are unlikely to select more life-sustaining treatment on older patients, a widespread advanced care planning has potentially contributed to promoting the decision-making [ 44 , 45 ]. In addition, the increasing population of 80- and 90-year-olds, which characterizes the first super-aging society, is potentially attributed to the surge in medical costs [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database

et al. 2022

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Background Sepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined. Methods We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. We investigated the annual trend of medical costs during the study period. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to evaluate the association between the annual trend and medical costs. Results Among 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017, whereas the total medical cost per hospitalization declined (rate = − $1075/year, p < 0.0001). While the survival rate of sepsis patients improved during the study period, the effective cost per survivor significantly decreased (rate = − $1806/year [95% CI − $2432 to − $1179], p = 0.001). In the subgroup analysis, the trend of decreasing medical cost per hospitalization remained consistent among the subpopulation of age, sex, and site of infection. After adjusting for age, sex (male), number of chronic diseases, site of infection, intensive care unit (ICU) admission, surgery, and length of hospital stay, the admission year was significantly associated with reduced medical costs. Conclusions We demonstrated an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. The annual trend of reduced costs was consistent after adjustment with the confounders altering hospital expenses.

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“…In addition, advance care planning may not be realized even after the start of home care in Japan. A study by Miyashita et al ., 27 revealed that over half of Japanese physicians preferred not to do advance care planning until just before the end of a patient's life.…”

Section: Discussionmentioning

confidence: 99%

Death at home versus other locations in older people receiving physician‐led home visits: A multicenter prospective study in Japan

Watanabe

Matsushima

Kaneko

et al. 2022

Geriatrics Gerontology Int

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Background The Japanese government is promoting physician‐led home visits as well as end‐of‐life care at home. However, the proportion of deaths occurring at home has remained unchanged for the past 20 years. Objectives To report the cumulative incidence of deaths at home and to explore the factors associated with deaths at home versus other places, mainly hospitals. Methods This was a multicenter prospective cohort study in a primary care setting. We enrolled patients aged ≥65 years who had started to receive regular visits by family physicians from 13 facilities in and around Tokyo between February 1, 2013 and January 31, 2016. Patients were followed‐up until January 31, 2017. The primary outcome measures were mortality rate and cumulative incidence of deaths at home. Results We enrolled 762 patients. Of 368 deaths, 133 occurred in the patient's home. The mortality rates at home were 137.6/1000 person‐years (95% confidence interval 116.1–163.1). In cumulative incidence function, the longer duration of care at home lowers the likelihood of death at home. Multivariable multinomial logistic models showed that younger age and higher Barthel Index score reduced the likelihood of deaths at home, while receiving oxygen therapy and the presence of a full‐time caregiver increased the likelihood of deaths at home relative to deaths at other locations. Conclusions Of deceased patients, only one‐third died in patients' homes. We found several factors associated with deaths at home, which appeared to reflect the readiness of patients and their families for death. Geriatr Gerontol Int 2022; 22: 1005–1012.

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Healthcare Providers’ Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study

Cited by 12 publications

References 32 publications

Evaluation of an advance care planning training program for practice professionals in Japan incorporating shared decision making skills training: a prospective study of a curricular intervention

Evaluation of an advance care planning training program for practice professionals in Japan incorporating shared decision making skills training: a prospective study of a curricular intervention

Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database

Death at home versus other locations in older people receiving physician‐led home visits: A multicenter prospective study in Japan

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