Relationship between patient-centred care and advance care planning among home medical care patients in Japan: the Zaitaku evaluative initiatives and outcome study

Abstract

Background There is a growing need to realize high-quality end-of-life care at home that respects the patient’s wishes. Objective To examine the association between the quality of primary care and advance care planning (ACP) participation among patients receiving home-based medical care. Methods In this multicentre, cross-sectional study, 29 home medical care clinics in Japan were included. Adult Japanese patients receiving home medical care were surveyed to assess their consideration of ACP. The quality of primary care, which reflects patient-centredness, was assessed with the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF). Information on the clinical conditions that require home medical care was collected from physicians. Results Of the 194 patients surveyed from 29 home medical services, 62 patients (32%) showed signs of ACP participation. Lack of opportunities was the most common reason for not participating in the ACP. In a multivariable-adjusted generalized estimating equation, primary care quality was associated with ACP participation (per 10-point increase, adjusted odds ratio: 1.96, 95% confidence interval: 1.51–2.56). In addition, all domains of the JPCAT-SF were associated with ACP participation. Conclusions Patient-centredness in home medical care facilitates the initiation of ACP participation.

Association Between Person-Centered Care Quality and Advance Care Planning Participation in Patients Undergoing Hemodialysis: A Multicenter Cross-Sectional Study

“…20 However, the studies that examined ACP participation that was associated with day-to-day person-centered care were reported only in the non-kidney primary care outpatient setting and in home medical care settings. 15,16 Second, although one study quantitatively evaluated nephrologists' person-centered care toward patients with chronic kidney disease (CKD), 13 the measures associated with it were confined to physician-patient relationships (degree of reliance on nephrologists for care) and were not directed toward decision-making processes such as ACP. Consequently, our study is the first to quantitatively demonstrate the potential for greater levels of day-to-day person-centered care for patients undergoing dialysis to foster favorable physician-patient interactions 7 and increase the opportunity for ACP participation.…”

“…33,34 Community orientation, which reflects a community-oriented approach, may enable the presentation of pragmatic options for end-of-life care through the effective use of healthcare resources where patients on dialysis live. 16…”

“…(check all items that apply).” Multiple options were offered, encompassing the ensuing responses: “I have not thought about this,” “I have thought about this, but have not talked about it to a family member, others (including a friend), or my doctor,” “I have talked about this with a family member or others (including a friend),” “I have talked about this with my doctor,” or “I have written a document or memo about my preferences.” The inclusion criterion for ACP participation was operationalized when participants selected either the response option “I have talked about this with my doctor” or “I have written a document or memo about my preferences” because recent studies concerning ACP interventions have employed a combination of effective communication and the formalization of advance directives. 15,16,19,20…”

“…The inclusion criterion for ACP participation was operationalized when participants selected either the response option "I have talked about this with my doctor" or "I have written a document or memo about my preferences" because recent studies concerning ACP interventions have employed a combination of effective communication and the formalization of advance directives. 15,16,19,20…”

Relationship of life expectancy with quality of life and health-related hope among Japanese patients receiving home medical care: The Zaitaku Evaluative Initiatives and Outcome Study

“…Twenty-nine home medical care facilities in the Tokyo Metropolitan area, Nara, and Nagasaki Prefectures were included in the study. In Japan, home medical care is usually provided by primary care physicians or hospitalists who are primarily engaged in such services [ 22 ], so we will use the term "home medical care facilities" for facilities that have the functions to provide home medical care services. Subspecialty certification is not required to provide home medical care: palliative care training prior to home medical care is left to individual physicians, and for example, the use of sedatives for end-of-life care in home medical settings is determined by the physician’s experience.…”