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Okamura N, Kubo E, Ishida A, Noda S, Harada M, Ishizuka K, Inoue Y, Kosugi K, Miura T. Differences in discharge letter content: oncologists' vs. home care physicians' needs. Support Care Cancer 2024; 32:299. [PMID: 38644420 DOI: 10.1007/s00520-024-08507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To compare the details, oncologists include in discharge letters with what home care physicians need. Although discharge letters are important to share patients' information for home palliative care, few studies have compared the details, especially patients' emotions, regarding what oncologists include in discharge letters and home care physicians' needs. METHODS This cross-sectional study was conducted by sending anonymous, self-administered questionnaires to 500 certified oncologists (OCs) and 500 directors of home care supporting clinics (HCs) in Japan between March and May 2023. The survey considered 20 potential items found in discharge letters, and compared rates of OCs including these items and HCs needs. RESULTS Of 310 valid responses, 186 were from OCs (average age: 47.7; 29 females) and 124 from HCs (average age: 55.4; 9 females). Major items with lower inclusion rates for OCs included patients' emotions regarding medical conditions (58.4% in OCs vs. 92.6% in HCs, p < 0.001), families' emotions regarding medical conditions (60.0 vs. 92.6%, respectively, p < 0.001), patients' perceptions regarding medical conditions (84.9 vs. 94.3%, respectively, p = 0.011), families' perceptions regarding medical conditions (84.3 vs. 95.1%, respectively, p = 0.004), and potential late-onset treatment-related adverse events (79.3 vs. 92.6%, respectively, p = 0.002). Conversely, OCs included patients' activities of daily living more frequently (96.2 vs. 90.2%, respectively, p = 0.031). CONCLUSION Transitioning to home-based palliative care may necessitate accurate information and consideration of patients' and families' perceptions and emotions regarding medical conditions in discharge letters for continuous provision of high-quality care.
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Affiliation(s)
- Nozomi Okamura
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Nephrology, Aso Iizuka Hospital, Iizuka, Japan
| | - Emi Kubo
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Ayaka Ishida
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Sakiho Noda
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Mariko Harada
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Keisuke Ishizuka
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yujiro Inoue
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan.
- Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Japan.
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Ozeki-Hayashi R, Wilkinson DJ. Journey to Narayama: Cultural Complexities, Psychedelics and Dementia. AJOB Neurosci 2023; 14:145-147. [PMID: 37097874 DOI: 10.1080/21507740.2023.2188309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
| | - Dominic Jc Wilkinson
- University of Oxford
- John Radcliffe Hospital
- Murdoch Children's Research Institute
- Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine
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3
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Obama K, Fujimori M, Okamura M, Kadowaki M, Ueno T, Boku N, Mori M, Akechi T, Yamaguchi T, Oyamada S, Okizaki A, Miyaji T, Sakurai N, Uchitomi Y. Effectiveness of a facilitation programme using a mobile application for initiating advance care planning discussions between patients with advanced cancer and healthcare providers: protocol for a randomised controlled trial (J-SUPPORT 2104). BMJ Open 2023; 13:e069557. [PMID: 36977536 PMCID: PMC10069562 DOI: 10.1136/bmjopen-2022-069557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Timely implementation of the discussion process of advance care planning (ACP) is recommended. The communication attitude of healthcare providers is critical in ACP facilitation; thus, improving their communication attitudes may reduce patient distress and unnecessary aggressive treatment while enhancing care satisfaction. Digital mobile devices are being developed for behavioural interventions owing to their low space and time restrictions and ease of information sharing. This study aims to evaluate the effectiveness of an intervention programme using an application intended to facilitate patient questioning behaviour on improving communication related to ACP between patients with advanced cancer and healthcare providers. METHODS AND ANALYSIS This study uses a parallel-group, evaluator-blind, randomised controlled trial design. We plan to recruit 264 adult patients with incurable advanced cancer at the National Cancer Centre in Tokyo, Japan. Intervention group participants use a mobile application ACP programme and undergo a 30 min interview with a trained intervention provider for discussions with the oncologist at the next patient visit, while control group participants continue their usual treatment. The primary outcome is the oncologist's communication behaviour score assessed using audiorecordings of the consultation. Secondary outcomes include communication between patients and oncologists and the patients' distress, quality of life, care goals and preferences, and medical care utilisation. We will use a full analysis set including the registered participant population who receive at least a part of the intervention. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the Scientific Advisory Board of the Japan Supportive, Palliative and Psychosocial Oncology Group (Registration No. 2104) and the Institutional Review Board of the National Cancer Centre Hospital (registration No. 2020-500). Written informed consent is obtained from the patients. The results of the trial will be published in peer-reviewed scientific journals and presented at scientific meetings. TRIAL REGISTRATION NUMBERS UMIN000045305, NCT05045040.
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Affiliation(s)
- Kyoko Obama
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Maiko Fujimori
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Masako Okamura
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Midori Kadowaki
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | | | - Narikazu Boku
- Department of Oncology and General Medicine, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Ayumi Okizaki
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Tempei Miyaji
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Naomi Sakurai
- Cancer Survivors Recruiting Project, General Incorporated Association, Tokyo, Japan
| | - Yosuke Uchitomi
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Chuo-ku, Japan
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4
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Asaumi K, Oki M, Murakami Y. Timely Identification of Patients With Cancer and Family Caregivers in Need of End-of-Life Discussions by Home-Visit Nurses in Japan: A Qualitative Descriptive Study. Glob Qual Nurs Res 2023; 10:23333936221146048. [PMID: 36644373 PMCID: PMC9834930 DOI: 10.1177/23333936221146048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023] Open
Abstract
End-of-life (EOL) discussions for patients with cancer are a key factor of successful EOL care; however, identifying the optimal timing for these discussions in Japanese home-care settings is difficult. To identify the time at which patients with cancer and their caregivers need EOL discussions, we explored when home-visit nurses start EOL discussions. We interviewed 23 home-visit nurses and analyzed the data using qualitative content analysis. Three themes were derived from the analysis. Participants identified the timing of EOL discussions as being sensitive to patients' changing health and care needs (increases in patient's total pain), changes in the family caregiver's physical or mental condition through daily care (increases in family caregiver distress), and the EOL process that patients follow (trajectory of disease). Developing a tool or in-service educational program that will enable inexperienced or new graduate home-visit nurses to implement EOL discussions at appropriate times is necessary.
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Affiliation(s)
- Kurumi Asaumi
- Tokyo University of Technology, Ota-ku,
Tokyo, Japan,Kurumi Asaumi, Tokyo University of
Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo 144-8535, Japan.
| | - Masataka Oki
- Tokyo University of Technology, Ota-ku,
Tokyo, Japan
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Miyashita J, Shimizu S, Shiraishi R, Mori M, Okawa K, Aita K, Mitsuoka S, Nishikawa M, Kizawa Y, Morita T, Fukuhara S, Ishibashi Y, Shimada C, Norisue Y, Ogino M, Higuchi N, Yamagishi A, Miura Y, Yamamoto Y. Culturally Adapted Consensus Definition and Action Guideline: Japan's Advance Care Planning. J Pain Symptom Manage 2022; 64:602-613. [PMID: 36115500 DOI: 10.1016/j.jpainsymman.2022.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT A conceptual framework for advance care planning is lacking in societies like Japan's valuing family-centered decision-making. OBJECTIVES A consensus definition of advance care planning with action guideline adapted to Japanese society. METHODS We conducted a multidisciplinary modified Delphi study 2020-2022. Thirty physicians, 10 healthcare and bioethics researchers, six nurses, three patient care managers, three medical social workers, three law experts, and a chaplain evaluated, in 7 rounds (including two web-based surveys where the consensus level was defined as ratings by ≥70% of panelists of 7-9 on a nine-point Likert scale), brief sentences delineating the definition, scope, subjects, and action guideline for advance care planning in Japan. RESULTS The resulting 29-item set attained the target consensus level, with 72%-96% of item ratings 7-9. Advance care planning was defined as "an individual's thinking about and discussing with their family and other people close to them, with the support as necessary of healthcare providers who have established a trusting relationship with them, preparations for the future, including the way of life and medical treatment and care that they wish to have in the future." This definition/action guideline specifically included support for individuals hesitant to express opinions to develop and express preparations for the future. CONCLUSION Adaptation of advance care planning to Japanese culture by consciously enhancing and supporting individuals' autonomous decision-making may facilitate its spread and establishment in Japan and other societies with family-centered decision-making cultures.
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Affiliation(s)
- Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University.
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University
| | - Ryuto Shiraishi
- Department of Palliative Medicine, Kobe University School of Medicine
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital
| | | | - Kaoruko Aita
- Uehiro Division for Death & Life Studies and Practical Ethics, The University of Tokyo
| | | | - Mitsunori Nishikawa
- Department of Palliative Care, National Center for Geriatrics and Gerontology
| | | | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | | | - Chiho Shimada
- Faculty of Humanities and Social Science, Saku University
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Mieko Ogino
- Department of Neurology, Ichikawa Hospital, International University of Health and Welfare
| | | | - Akemi Yamagishi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University
| | - Yasuhiko Miura
- Department of General Medicine, The Jikei University School of Medicine
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University
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6
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Autonomy in Japan: What does it Look Like? Asian Bioeth Rev 2022; 14:317-336. [PMID: 36203709 PMCID: PMC9530074 DOI: 10.1007/s41649-022-00213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
This paper analysed the nature of autonomy, in particular respect for autonomy in medical ethics/bioethics in Japan. We have undertaken a literature survey in Japanese and English and begin with the historical background and explanation of the Japanese word Jiritsu (autonomy). We go on to identify patterns of meaning that researchers use in medical ethics / bioethics discussions in Japan, namely, Beauchamp and Childress’s individual autonomy, relational autonomy, and O’Neill’s principled autonomy as the three major ways that autonomy is understood. We examine papers discussing these interpretations. We propose using the term ‘a form of autonomy’ first used by Edmund Pellegrino in 1992 and examine the nature of ‘a form of autonomy.’ We finally conclude that the crux of what Pellegrino calls ‘something close to autonomy,’ or ‘a form of autonomy' might best be understood as the minimization of physician paternalism and the maximization of respect for patient preference. Simultaneously, we introduce a family-facilitated approach to informed consent and respond to criticism by Laura Sullivan. Finally, we discuss cross-cultural approaches and global bioethics. Furthermore, we use the term ‘Bioethics across the Globe’ instead of ‘Global Bioethics’, calling for international scholars to write works to provide an in-depth understanding of each country. We conclude that deep understanding of others is pivotal for dialogue to be of value. We hope this article will deepen the reader’s understanding of Japan and will contribute to the progress of bioethics worldwide.
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7
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Martina D, Geerse OP, Lin CP, Kristanti MS, Bramer WM, Mori M, Korfage IJ, van der Heide A, Rietjens JAC, van der Rijt CCD. Asian patients' perspectives on advance care planning: A mixed-method systematic review and conceptual framework. Palliat Med 2021; 35:1776-1792. [PMID: 34488509 PMCID: PMC8637390 DOI: 10.1177/02692163211042530] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Asian healthcare professionals hold that patients' families play an essential role in advance care planning. AIM To systematically synthesize evidence regarding Asian patients' perspectives on advance care planning and their underlying motives. DESIGN Mixed-method systematic review and the development of a conceptual framework (PROSPERO: CRD42018099980). DATA SOURCES EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for studies published until July 27, 2020. We included studies concerning seriously-ill Asian patients' perspectives on advance care planning or their underlying motives for engaging or not engaging in it. RESULTS Thirty-six articles were included; 22 were quantitative and 27 were from high-income countries. Thirty-nine to ninety percent of Asian patients were willing to engage in advance care planning. Our framework highlighted that this willingness was influenced not only by their knowledge of their disease and of advance care planning, but also by their beliefs regarding: (1) its consequences; (2) whether its concept was in accordance with their faith and their families' or physicians' wishes; and (3) the presence of its barriers. Essential considerations of patients' engagement were their preferences: (1) for being actively engaged or, alternatively, for delegating autonomy to others; (2) the timing, and (3) whether or not the conversations would be documented. CONCLUSION The essential first step to engaging patients in advance care planning is to educate them on it and on their diseases. Asian patients' various beliefs about advance care planning should be accommodated, especially their preferences regarding their role in it, its timing, and its documentation.
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Affiliation(s)
- Diah Martina
- Department of Medical Oncology, Erasmus
MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The
Netherlands
- Department of Public Health, Erasmus
MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Psychosomatic and
Palliative Medicine, Department of Internal Medicine, Universitas Indonesia,
Jakarta, Indonesia
- Dr. Cipto Mangunkusumo National Center
Hospital, Jakarta, Indonesia
| | - Olaf P Geerse
- Department of Internal Medicine,
Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Cheng-Pei Lin
- Institute of Community Health Care,
School of Nursing, National Yang Ming Chiao Tung University, Taipei
- Florence Nightingale Faculty of
Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative
Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Martina S Kristanti
- School of Nursing, Faculty of Medicine,
Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University
Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Masanori Mori
- Palliative and Supportive Care
Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Ida J Korfage
- Department of Public Health, Erasmus
MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus
MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith AC Rietjens
- Department of Public Health, Erasmus
MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carin CD van der Rijt
- Department of Medical Oncology, Erasmus
MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The
Netherlands
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Miyashita J, Kohno A, Shimizu S, Kashiwazaki M, Kamihiro N, Okawa K, Fujisaki M, Fukuhara S, Yamamoto Y. Healthcare Providers' Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study. J Gen Intern Med 2021; 36:2935-2942. [PMID: 33547574 PMCID: PMC8481514 DOI: 10.1007/s11606-020-06524-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, 2-1 Toyochikamiyajiro, Shirakawa, Fukushima, 961-0005, Japan. .,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Ayako Kohno
- Internationalization Promotion Office, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Institute for Health Outcomes & Process Evaluation Research (iHope International), Kyoto, Japan
| | | | - Noriki Kamihiro
- The Kansai Centre for Family Medicine, Kanai Hospital, Kyoto, Japan
| | - Kaoru Okawa
- Department of Home Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Masami Fujisaki
- Department of General Medicine, Medical Center Narita Hospital, Chiba, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, 2-1 Toyochikamiyajiro, Shirakawa, Fukushima, 961-0005, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Factors associated with surrogate families’ life-sustaining treatment preferences for patients at home or in a geriatric health service facility: A cross-sectional study. Palliat Support Care 2021; 20:334-341. [DOI: 10.1017/s1478951521001401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective
Recently, end-of-life preference in palliative care has been gaining attention in Japan. The Ministry of Health, Labor, and Welfare established the Japanese basic policy in November 2018. Patients’ decision-making is recommended; however, patients with dementia or other disorders cannot make such decisions by themselves. Thus, healthcare providers may contact surrogates and consider their backgrounds for better decision-making. Hence, the preferences of home caregivers’ and geriatric health service facility (GHSF) residents’ families on patient life-sustaining treatment (LST) were investigated.
Method
This cross-sectional study involved home caregivers’ and GHSF residents’ families in Japan. We distributed 925 self-reported questionnaires comprising items, such as the number of people living together, care duration, comprehension of doctor's explanations, the Patient Health Questionnaire (PHQ)-9 and Short Form (SF)-8, and families’ LST preference for patients.
Results
In all, 619 valid responses were obtained [242 men and 377 women (309 in the HOME Caregivers Group, response rate = 61.1%; 310 in the GHSF Group, response rate = 74.0%)]. LST preference was significantly associated with sex, the number of people living together, care duration, and comprehension of doctors’ explanations in the HOME Caregivers Group but was not significantly associated with the GHSF Group. Furthermore, PHQ-9/SF-8 scores were not significantly associated with LST preference.
Significance of results
There were many differences in opinions about LST preference between home caregivers’ and GHSF residents’ families. The results suggested that the burden of nursing care was greater and harder in home caregiver families, and these factors may be related to the LST preference for a patient.
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10
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Chubachi K, Umihara J, Yoshikawa A, Nakamichi S, Takeuchi S, Matsumoto M, Miyanaga A, Minegishi Y, Yamamoto K, Seike M, Gemma A, Kubota K. Evaluation of a Tool that Enables Cancer Patients to Participate in the Decision-Making Process during Treatment Selection. J NIPPON MED SCH 2021; 88:273-282. [PMID: 32612013 DOI: 10.1272/jnms.jnms.2021_88-401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patient participation in decisions related to their treatment is strongly recommended. This study was conducted to develop and evaluate a support tool that can help patients make decisions related to their own treatment. METHODS Twenty cancer patients who were hospitalized for first-line treatment were enrolled. Before hospitalization, a 'Check sheet on treatment selection', which contained 14 questions, was distributed to patients and/or their families. After hospitalization, the attending physician explained the treatment while referring to the written check sheet. At discharge, patients' responses to the 'Questionnaire on check sheet and treatment selection' were collected to evaluate the utility of the check sheet. Finally, the 'Questionnaire of the check sheet' was handed to the attending physician to evaluate. RESULTS Of the fourteen patients who responded to the questionnaire, all indicated that the check sheets were helpful for decision-making and that using the sheets empowered them to ask their doctors questions. Only one person felt uncomfortable with compiling the check sheet. Physicians stated that the check sheet facilitated patient decision-making and improved communication with patients. However, some felt that this activity increased the administrative burden of medical professionals. CONCLUSION Almost all patients stated that the present check sheet was useful as a decision support tool and facilitated communication between doctors and patients. Before incorporation into general clinical practice, this increased benefit should be weighed against the potential extra administrative workload imposed on clinicians.
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Affiliation(s)
- Kumi Chubachi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | | | - Akiko Yoshikawa
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Susumu Takeuchi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Masaru Matsumoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Yuji Minegishi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Kazuo Yamamoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
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11
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Shaku F, Yada Y, Tsutsumi M, Kim WS. Characterising end-of-life decision-making of life-sustaining treatment among Japanese nurses. Int J Palliat Nurs 2021; 27:213-218. [PMID: 34169740 DOI: 10.12968/ijpn.2021.27.4.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Often, nurses are closer to end-of-life (EOL) patients than other medical professionals, due to the time they spend with them at their bedside, which leads them to understand patients' care goals. AIMS To investigate the importance of EOL preferences by examining nurses' EOL decision-making regarding life-sustaining treatment (LST). METHODS In this cross-sectional study, 559 self-reported questionnaires of Japanese nurses were examined. Marital status, age and decision-making regarding LST for themselves were investigated. FINDINGS Unmarried participants from all age groups had a higher percentage of 'no preference for LST' than married groups. Differences between the percentages were higher in the 20s age group. Married participants increasingly preferred to receive no LST as their age increased, unlike single participants. CONCLUSION Marital status influences Japanese nurses' EOL decision-making regarding LST. Therefore, it is necessary to consider a patient's marital status to facilitate better decision-making.
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Affiliation(s)
- Fumio Shaku
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan; Department of Psychosomatic Internal Medicine, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yoichi Yada
- Division of Pharmacology, Nihon University School of Medicine, Tokyo, Japan
| | | | - Woe Sook Kim
- College of Nursing Art and Science, University of Hyogo, Japan
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12
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Advance Care Planning in Asia: A Systematic Narrative Review of Healthcare Professionals’ Knowledge, Attitude, and Experience. J Am Med Dir Assoc 2021; 22:349.e1-349.e28. [DOI: 10.1016/j.jamda.2020.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
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13
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Cheng SY, Lin CP, Chan HYL, Martina D, Mori M, Kim SH, Ng R. Advance care planning in Asian culture. Jpn J Clin Oncol 2020; 50:976-989. [PMID: 32761078 DOI: 10.1093/jjco/hyaa131] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/20/2020] [Indexed: 11/14/2022] Open
Abstract
Ageing has been recognized as one of the most critically important health-care issues worldwide. It is relevant to Asia, where the increasing number of older populations has drawn attention to the paramount need for health-care investment, particularly in end-of-life care. The advocacy of advance care planning is a mean to honor patient autonomy. Since most East Asian countries are influenced by Confucianism and the concept of 'filial piety,' patient autonomy is consequently subordinate to family values and physician authority. The dominance from family members and physicians during a patient's end-of-life decision-making is recognized as a cultural feature in Asia. Physicians often disclose the patient's poor prognosis and corresponding treatment options to the male, family member rather to the patient him/herself. In order to address this ethical and practical dilemma, the concept of 'relational autonomy' and the collectivism paradigm might be ideally used to assist Asian people, especially older adults, to share their preferences on future care and decision-making on certain clinical situations with their families and important others. In this review article, we invited experts in end-of-life care from Hong Kong, Indonesia, Japan, South Korea, Singapore and Taiwan to briefly report the current status of advance care planning in each country from policy, legal and clinical perspectives. According to the Asian experiences, we have seen different models of advance care planning implementation. The Asian Delphi Taskforce for advance care planning is currently undertaken by six Asian countries and a more detailed, culturally sensitive whitepaper will be published in the near future.
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Affiliation(s)
- Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Cheng-Pei Lin
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Central Ave, Hong Kong
| | - Diah Martina
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine Universitas Indonesia, Jakarta Pusat, Indonesia
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Republic of Korea
| | - Raymond Ng
- Department of Palliative Medicine, Tan Tock Seng Hospital, Jln Tan Tock Seng, Singapore
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14
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Miyashita J, Kohno A, Yamamoto Y, Shimizu S, Azuma T, Takada T, Hayashi M, Fukuhara S. How Psychosocial Factors Contribute to Japanese Older Adults’ Initiation of Advance Care Planning Discussions: A Qualitative Study. J Appl Gerontol 2020; 40:1180-1188. [DOI: 10.1177/0733464820911537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: This study aimed to reveal the features of older adults’ advance care planning (ACP) discussions by identifying psychosocial factors related to their discussions in Japan, where people value family-centered decision making. Methods: A qualitative study using in-depth interviews was conducted with 39 participants (aged ≥65 years) recruited from the outpatient department of a community hospital in Fukushima, Japan. Data were analyzed using the grounded theory approach. Results: Through experiences of family caregiving, participants became aware of their own feelings about the end of life. Equal relationship with family members was important for lowering the threshold for having discussions. Some participants and their families in the same generation reached agreements on ACP; however, they were willing to yield to children’s decision making despite these discussions. Discussions: These findings provide insights into the psychosocial factors in relation to ACP discussions and support for the role of ACP discussions in the family-centered decision-making culture.
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Affiliation(s)
- Jun Miyashita
- Fukushima Medical University, Japan
- Kyoto University, Japan
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15
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Strupp J, Köneke V, Rietz C, Voltz R. Perceptions of and Attitudes Toward Death, Dying, Grief, and the Finitude of Life-A Representative Survey Among the General Public in Germany. OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:157-176. [PMID: 31615342 DOI: 10.1177/0030222819882220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Some end-of-life aspects have become a significant political and social issue such as elderly care and euthanasia. But hardly anything is known about how the general public in Germany thinks about death and dying more generally. Therefore, we conducted a representative online survey (N = 997) regarding 21 end-of-life aspects. Differences between subgroups were analyzed by conducting analyses of variance and Tukey honestly significance difference post hoc tests and by performing t tests. The findings revealed that the general public is open to engaging with topics of death, dying, and grief and that death education might even be promoted for children. Most participants appraised dealing with the finitude of life as part of a good life, but few have contemplated death and dying themselves so far. Attitudes and perceptions were related to age, subjective health, religious denomination, and gender. The survey provides useful implications for community palliative care, death education, and communication with dying people.
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Affiliation(s)
- Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Germany
| | - Vanessa Köneke
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Germany.,Cologne Graduate School in Management, Economics and Social Sciences, University of Cologne, Germany
| | - Christian Rietz
- Department of Educational and Social Sciences, University of Education Heidelberg, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital, University of Cologne, Germany.,Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital, University of Cologne, Germany.,Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Germany
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16
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Lee JE, Goo A, Shin DW, Yoo JH. Korean Medical Professionals' Attitudes and Experiences on Advance Care Planning for Noncancerous Disease. Ann Geriatr Med Res 2019; 23:63-70. [PMID: 32743290 PMCID: PMC7387591 DOI: 10.4235/agmr.19.0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/19/2019] [Accepted: 05/22/2019] [Indexed: 11/02/2022] Open
Abstract
Background Advance care planning (ACP) allows patients to declare their preferences for life-sustaining and hospice palliative care. However, the perception of ACP remains low in Korea. The present study assessed the attitudes and status of medical professionals in relation to end-of-life care decisions in older and noncancerous patients. Methods This descriptive correlation study was performed to understand the attitudes regarding and status of ACP and advance directives (AD). For this purpose, we conducted a survey of members who attended the Spring Conference of the Korean Geriatrics Society in May 2015 using a questionnaire that included questions on experiences related to AD, opinions on disturbance factors and improvement measures, and questions about the status of their medical institutions. Results All of 181 respondents were doctors. Among the respondents, 21.7% had the experience of treating patients who had completed an AD. Medical professionals saw AD use as appropriate for terminal patients with less than 6 months of life expectancy, as well as those with degenerative neurological disorders such as amyotrophic lateral sclerosis, chronic diseases such as chronic renal disease, and early stages of Alzheimer's disease. Conclusion The results showed that geriatrics medical professionals agreed with the necessity for AD in noncancerous terminal diseases and that consideration of a family-centered decision-making culture, legal protection for medical professionals, and education of the general public and medical professionals will be helpful for the popularization of AD.
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Affiliation(s)
- Ji Eun Lee
- Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Aejin Goo
- Department of Family Medicine, National Center for Mental Health, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Jun Hyun Yoo
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Mori M, Fujimori M, van Vliet LM, Yamaguchi T, Shimizu C, Kinoshita T, Morishita-Kawahara M, Inoue A, Inoguchi H, Matsuoka Y, Bruera E, Morita T, Uchitomi Y. Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video-vignette study (J-SUPPORT1601). Cancer 2019; 125:3320-3329. [PMID: 31206639 DOI: 10.1002/cncr.32327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/31/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nondisclosure of a poor prognosis to patients with advanced cancer remains a typical practice in Asia. Although the importance of prognostic communication has increasingly been recognized worldwide, little is known about whether explicit prognostic disclosure positively affects Asian patients with advanced cancer. The objective of this study was to examine the effects of explicit prognostic communication on patients with cancer recurrence. METHODS In this randomized, video-vignette study, Japanese women with breast cancer who had undergone curative surgery viewed videos of prognostic communication between a patient with recurrent, incurable breast cancer and her oncologist. The videos differed only in the presence or absence of explicit prognostic disclosure. The primary outcome was participants' uncertainty (rated from 0 to 10), and the secondary outcomes included anxiety (measured on the State-Trait Anxiety Inventory-State: range, 20-80), satisfaction (Patient Satisfaction Questionnaire; range 0-10), self-efficacy (range, 0-10), and willingness to discuss advance care planning (range, 1-4). RESULTS In total, 105 women participated (mean ± SD age, 53.8 ± 8.2 years). After viewing the video with more versus less explicit disclosure, participants showed significantly lower uncertainty (mean ± SE scores, 5.3 ±0.2 vs 5.7 ± 0.2, respectively; P = .032) and higher satisfaction (5.6 ± 0.2 vs 5.2 ± 0.2, respectively; P = .010) without increasing anxiety (changes in scores on the State-Trait Anxiety Inventory-State: 0.06 ± 0.5 vs 0.6 ± 0.5, respectively; P = .198). No significant differences were observed in self-efficacy (5.2 ± 0.2 vs 5.0 ± 0.2, respectively; P = .277) or willingness to discuss advance care planning (2.7 ± 0.1 vs 2.7 ± 0.1, respectively; P = .240). CONCLUSIONS Explicit prognostic disclosure prompted better outcomes than nondisclosure in Japanese women with breast cancer. When asked about the prognosis by Asian patients with cancer, clinicians may be encouraged to respect their wishes and explicitly discuss the prognosis if deemed appropriate.
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Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan.,Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Maiko Fujimori
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Liesbeth M van Vliet
- Department of Communication, Nivel-Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of Health, Medical, and Neuropsychology, Leiden University, Leiden, Netherlands
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chikako Shimizu
- Department of Breast Medical Oncology, National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Miki Morishita-Kawahara
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Hironobu Inoguchi
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Matsuoka
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yosuke Uchitomi
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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18
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Miyashita J, Yamamoto Y, Shimizu S, Aoki T, Azuma T, Takada T, Hayashi M, Kimachi M, Ikenoue T, Fukuma S, Fukuhara S. Association between social networks and discussions regarding advance care planning among Japanese older adults. PLoS One 2019; 14:e0213894. [PMID: 30908511 PMCID: PMC6433343 DOI: 10.1371/journal.pone.0213894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 03/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background Older adults’ discussions with family, or with physicians, or with both, about advance care planning (ACP) are increasingly regarded as important for the management of end-of-life care, and yet the factors that induce older adults to engage in ACP discussions are poorly understood. For example, in older adults, is stronger connectedness with family and friends (stronger “networks”) associated with ACP discussions? By facilitating, or by impeding ACP discussions? We sought to evaluate the associations between ACP discussions and social networks in Japanese older adults. Methods In July 2016 we conducted a cross-sectional survey on 355 community-dwelling patients aged ≥65 years visiting community hospital clinics in Fukushima, Japan. We used the Lubben Social Network Scale (LSNS-6, the shortest available LSNS scale) to assess social networks and recorded two components of social network structure, marital status (dichotomized as “married” vs. “single / other”) and living status (“living with others” vs. “living alone”). One item asked if patients had had ACP discussions. We analyzed the LSNS-6 social network and marital and living status data in relation to the occurrence of ACP discussions using multiple logistic regression models with adjustments for possible confounding factors. Results Respondents’ social network was “limited” in 16% of cases; 61% had had ACP discussions. Respondents with a limited social network had a significantly lower tendency to have had ACP discussions than respondents with an “adequate” social network (adjusted odds ratio [AOR]: 0.35; 95% confidence interval [CI]: 0.18–0.66; P < 0.001). Marital status and living status were not significantly associated with ACP discussion. Conclusions Among Japanese older adults, weaker social networks may be associated with a lower tendency to discuss ACP. Our findings may help practitioners to quickly screen populations at risk for inadequate ACP discussion by using the LSNS-6.
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Affiliation(s)
- Jun Miyashita
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuya Aoki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Miho Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
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19
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Teruya N, Sunagawa Y, Sunagawa H, Toyosato T. Visiting Nurses' Perspectives on Practices to Achieve End-of-Life Cancer Patients' Wishes for Death at Home: A Qualitative Study. Asia Pac J Oncol Nurs 2019; 6:389-396. [PMID: 31572759 PMCID: PMC6696802 DOI: 10.4103/apjon.apjon_18_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aimed to clarify visiting nurses’ perspectives on critical practices to ensure they could advocate for patients who prefer to die at home. Methods: Sixteen nurses, working at home-visit nursing agencies in Japan, participated in this study. Data were generated by interviews with the nurses and participant observations from nursing home-visits for six end-of-life cancer patients and were analyzed using content analysis. Results: Five themes emerged: (1) nursing assessment, (2) support for comfortable daily life of the patient and their family, (3) advocating for the patient's views about continuing homecare until death, (4) supporting the patient's preparedness for death, and (5) coordination with other health professionals and related facilities for a comfortable environment for the patient. In addition, the nurses sometimes used humorous responses to death-related work to change the patient's melancholy thoughts. Conclusion: The present study found that the participants advocated for the patient's views about continuing homecare until death while coordinating views between the patient and their family; they further supported the patient's daily life while helping them prepare for death to achieve their wish for death at home. In addition, our study uncovered the visiting nurses’ unconscious practical wisdom of using humorous responses to death-related work to alleviate the patients’ feelings of hopelessness. To develop practical wisdom for using humor effectively in end-of-life care, nurses need to verbalize unconscious practices, and accumulate empirical knowledge about nursing interventions using humor, including cultural attitudes, through case study analysis.
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Affiliation(s)
- Noriko Teruya
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa Prefecture, Japan
| | - Yoko Sunagawa
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa Prefecture, Japan
| | - Haru Sunagawa
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa Prefecture, Japan
| | - Takehiko Toyosato
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa Prefecture, Japan
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20
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Wilson DM, Houttekier D, Kunju SA, Birch S, Cohen J, MacLeod R, Hewitt JA. A Population-Based Study on Advance Directive Completion and Completion Intention among citizens of the Western Canadian province of Alberta. J Palliat Care 2018. [DOI: 10.1177/082585971302900102] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Determining what proportion of the public has completed an advance directive and which population subgroups complete or do not complete such a directive is crucially important for planning purposes. Our research objective was to examine and compare advance directive completion, intention to complete, and noncompletion rates among citizens of one Canadian province. A telephone survey was conducted with 1,203 Albertans who met gender, age, and other requirements for a representative sample. When asked, “Do you have a living will or personal directive?” 43.6 percent reported having completed a directive and 42.1 percent indicated that they planned or intended to complete one. Completion rates increased with age. Widowed, self-employed, and retired people, and those who had lost a family member or friend and had other select end-of-life experiences and viewpoints were significantly more likely to have completed one. Although older people more often had an advance directive, personal life-and-death experiences should be recognized as major influences on directive completion.
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Affiliation(s)
- Donna M. Wilson
- DM Wilson (corresponding author): Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta, Canada T6G 1C9
| | - Dirk Houttekier
- End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium
| | - Sabu Aliyar Kunju
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen Birch
- Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Joachim Cohen
- End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium
| | - Rod MacLeod
- Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jessica A. Hewitt
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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21
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Wilson DM, Fillion L, Thomas R, Justice C, Bhardwaj PP, Veillette AM. The “Good” Rural Death: A report of An Ethnographic Study in Alberta, Canada. J Palliat Care 2018. [DOI: 10.1177/082585970902500103] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Much concern has centred on the “good” death since the modern hospice/palliative care movement began, and considerable progress has been made in urban services to promote the good death. Little is known about the perspectives of people who live in rural and remote areas of Canada on the good death and how this good death might be enabled in those areas. This report is of an ethnographic study in rural Alberta involving English-speaking Albertans. An identical study in Quebec will be reported elsewhere. The 2006–07 Alberta study involved 13 interviews with individuals to understand their personal viewpoints or perspectives and how they were shaped by their experiences, followed by focus group discussions in two representative rural communities for additional insights from rural policy-makers and care providers. Four themes in the Alberta data highlight critical elements of the good rural death. These findings are expected to contribute to rural/remote palliative and end-of-life care developments.
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Affiliation(s)
- Donna M. Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Lise Fillion
- Faculty of Nursing, Laval University, and Laval University Cancer Research Center, CHUQ-HDQ, Quebec City, Quebec, Canada
| | - Roger Thomas
- Department of Family Medicine, University of Calgary, and University of Calgary Medical Clinics North Hill, Calgary, Alberta
| | - Christopher Justice
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Anne-Marie Veillette
- Centre de Recherche Clinique et Έvaluative en Oncologie de l'Hôtel-Dieu de Québec (CRCEO), Quebec City, Quebec, Canada
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22
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Tsuda S, Nakamura M, Aoki S, Ono H, Takagi M, Ohashi H, Miyachi J, Matsui Y, Ojima T. Impact of Patients' Expressed Wishes on Their Surrogate Decision Makers' Preferred Decision-Making Roles in Japan. J Palliat Med 2018; 21:354-360. [PMID: 29148907 DOI: 10.1089/jpm.2017.0226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shuji Tsuda
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Kikugawa Family Medicine Center, Kikugawa, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | | | | | | | - Junichiro Miyachi
- The Hokkaido Centre for Family Medicine, Hokkaido, Japan
- Center for Medical Education, Kyoto University, Kyoto, Japan
| | | | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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23
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Mori M, Kuwama Y, Ashikaga T, Parsons HA, Miyashita M. Acculturation and Perceptions of a Good Death Among Japanese Americans and Japanese Living in the U.S. J Pain Symptom Manage 2018; 55:31-38. [PMID: 28842219 DOI: 10.1016/j.jpainsymman.2017.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 11/30/2022]
Abstract
CONTEXT Acculturation is the phenomenon of the attitudinal changes of individuals who come into continuous contact with another culture. Despite the long history of Japanese immigration to America, little is known about the impact of acculturation on perceptions of a good death. OBJECTIVES To examine differences in perceptions of a good cancer death among Japanese Americans (JA/A), Japanese living in America (J/A), and the Japanese living in Japan (J/J). METHODS We administered surveys among JA/A and J/A and used historical J/J data for reference. Primary endpoint was the proportion of respondents who expressed the necessity of core and optional items of the Good Death Inventory. Group differences ≥20% were deemed clinically important. RESULTS In total, 441 survey responses in America and 2548 in Japan were obtained. More than 80% of respondents consistently considered nine of 10 core items necessary without significant group differences. No core item reached a ≥20% group difference. Three of the eight optional items reached ≥20% group difference: fighting against disease until one's last moment (49%, P < 0.0001; 52%, P < 0.0001; and 73% in JA/A, J/A, and J/J, respectively), knowing what to expect about one's condition in the future (83%, P < 0.0001; 80%, P < 0.0001; and 58%, respectively), and having faith (64%, P = 0.0548; 43%, P = 0.0127; and 38%, respectively). CONCLUSION Although most core items of a good death were preserved throughout the levels of acculturation, perceptions of some optional items shifted away from Japanese attitudes as individuals became more acculturated. Understanding of different levels of acculturation may help clinicians provide culturally sensitive end-of-life care.
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Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Shizuoka, Japan.
| | - Yuichiro Kuwama
- Mount Sinai Beth Israel, Japanese Medical Practice, New York, New York
| | - Takamaru Ashikaga
- Department of Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vermont
| | - Henrique A Parsons
- Department of Medicine/Division of Palliative Care, University of Ottawa, Ontario, Canada
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Omondi S, Weru J, Shaikh AJ, Yonga G. Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya. BMC Palliat Care 2017; 16:9. [PMID: 28118824 PMCID: PMC5264302 DOI: 10.1186/s12904-017-0186-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/19/2017] [Indexed: 11/14/2022] Open
Abstract
Background An advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on life-sustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of terminally ill patients with AD and to identify the factors that influence the completion of AD amongst terminally ill patients at a tertiary hospital in Kenya. Methods The study was a retrospective survey. All available records of terminally ill patients seen at Aga Khan University Hospital, Nairobi, between July 2010 and December 2015, and that met the inclusion criteria were included in the study. Results In total, 216 records of terminally ill patients were analyzed: 89 records were of patients that had AD and 127 records were of patients that did not have AD. The proportion of terminally ill patients that had completed AD was 41.2%. The factors that were associated with the completion of AD on bivariate analysis were history of ICU admission, history of endotracheal intubation, functional status of the patient, the medical specialty taking care of the patient, patient’s caregiver discussing the AD with the patient, and a palliative specialist review. On multivariate regression analysis, discussion of AD with a caregiver and patient’s functional impairment were the factors with statistically significant association with completion of AD. Conclusions The proportion of terminally ill patients that had AD in their medical records was significant. However, most terminally ill patients did not have AD. Our data, perhaps the first on the subject in East Africa, suggest that most of the factors associated with AD completion mirrored those seen in other regions of the world. Discussion between patient and their physician and patient’s functional impairment were the factors independently associated with completion of AD. Therefore, physicians need to be aware of the importance of discussions of AD with their patients.
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Affiliation(s)
| | - John Weru
- Aga Khan University-Kenya, Nairobi, Kenya
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Shaku F, Tsutsumi M. The Effect of Providing Life Support on Nurses’ Decision Making Regarding Life Support for Themselves and Family Members in Japan. Am J Hosp Palliat Care 2016; 33:917-923. [DOI: 10.1177/1049909115624655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Decision making in terminal illness has recently received increased attention. In Japan, patients and their families typically make decisions without understanding either the severity of illness or the efficacy of life-supporting treatments at the end of life. Japanese culture traditionally directs the family to make decisions for the patient. This descriptive study examined the influence of the experiences of 391 Japanese nurses caring for dying patients and family members and how that experience changed their decision making for themselves and their family members. The results were mixed but generally supported the idea that the more experience nurses have in caring for the dying, the less likely they would choose to institute lifesupport measures for themselves and family members. The results have implications for discussions on end-of-life care.
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Affiliation(s)
- Fumio Shaku
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Madoka Tsutsumi
- Primary Care and Medical Education, University of Tsukuba, Ibaraki, Japan
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Braun KL, Karel H, Zir A. Family Response to End-of-Life Education: Differences by Ethnicity and Stage of Caregiving. Am J Hosp Palliat Care 2016; 23:269-76. [PMID: 17060290 DOI: 10.1177/1049909106290243] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors developed and tested 5 educational booklets to improve end-of-life knowledge, attitudes, intention, and practices in a multiethnic sample of family caregivers of well, homebound, and institutionalized elders. Of 570 participants, 424 (74%) read at least 1 booklet and completed pretests and posttests. At 3-month follow-up, small improvements were seen in completion of advance directives, and significant increases were seen in proportions of caregivers with funeral or burial plans and willingness to consider hospice. The booklets had wide appeal, but end-of-life measures varied by care-giver stage and ethnicity, suggesting that these factors need to be considered in developing education interventions for family caregivers.
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Affiliation(s)
- Kathryn L Braun
- Center on Aging, Office of Public Health Studies, University of Hawaii, Honolulu, USA.
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Kim S, Lee Y. Korean Nurses’ Attitudes to Good and Bad Death, Life-Sustaining Treatment and Advance Directives. Nurs Ethics 2016; 10:624-37. [PMID: 14650481 DOI: 10.1191/0969733003ne652oa] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study was an investigation of which distinctive elements would best describe good and bad death, preferences for life-sustaining treatment, and advance directives. The following elements of a good death were identified by surveying 185 acute-care hospital nurses: comfort, not being a burden to the family, a good relationship with family members, a readiness to die, and a belief in perpetuity. Comfort was regarded as the most important. Distinctive elements of a bad death were: persistent vegetative state, sudden death, pain and agony, dying alone, and being a burden to the family. Of the 185 respondents, 90.8% answered that they did not intend to receive life-sustaining treatment if they suffered from a terminal illness without any chance of recovery; 77.8% revealed positive attitudes toward advance directives. Sixty-seven per cent of the respondents stated that they were willing to discuss their own death and dying; the perception of such discussions differed according to the medical condition ( p = 0.001). The elements of a bad death differed significantly depending on the disease state ( p = 0.003) and on economic status ( p = 0.023).
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Affiliation(s)
- Shinmi Kim
- Department of Nursing, Woosuk University, Chonbuk, South Korea.
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Pinquart M, SÖrensen S. Preparation for Death and Preparation for Care in Older Community-Dwelling Adults. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/5k9j-c320-22lq-kph6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Preparation for one's death (e.g., having signed a will, having made preparations for one's funeral) and preparation for future care needs (e.g., having selected a source of support) were investigated in 593 United States and 582 German independently living seniors. The older adults reported higher levels of preparation for death than preparation for care. The lower level of preparation for care is interpreted as reflecting the uncertainty whether care needs will emerge in the future. Seniors who reported some preparation for death were more likely to report preparation for future care needs as well. Older, more educated, and more religious individuals were more likely to prepare for death. In addition, U.S. seniors were more likely to report some death preparation than German seniors. Limitations in activities of daily living did not predict levels of preparation for death. Implications for future research and for psychosocial interventions are discussed.
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Need for palliative care for neurological diseases. Neurol Sci 2016; 37:1581-7. [DOI: 10.1007/s10072-016-2614-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/17/2016] [Indexed: 11/27/2022]
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Otte IC, Elger B, Jung C, Bally KW. The utility of standardized advance directives: the general practitioners' perspective. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2016; 19:199-206. [PMID: 26860626 PMCID: PMC4880623 DOI: 10.1007/s11019-016-9688-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Advance directives (AD) are written documents that give patients the opportunity to communicate their preferences regarding treatments they do or do not want to receive in case they become unable to make decisions. Commonly used pre-printed forms have different formats. Some offer space for patients to (a) appoint a surrogate decision maker, and/or (b) to determine future medical treatments and/or (c) give a statement of personal values. So far it is unknown which forms GPs preferably use and why they decide to do so. 23 semi-structured interviews with GPs were analysed using content analysis. Interviewees mainly use short templates (to appoint surrogate decision makers) and medium length templates with checkboxes to indicate patients' preferences in regards to life prolonging measures. Especially when patients faced the progression of a disease, participants use the latter version. Only then, the interviewees remarked, patients are capable to rate concrete situations reliably. GPs also realize the importance of the verbal assessment of patients' preferences; however they rarely keep a written form of the conversation. Some GPs hand out one or more templates and ask their patients to read and think about them at home with the option to talk to them about it later on, while others prefer their patients to fill them out alone at home. Regardless of template usage, most GPs emphasize that ADs require regular updates. GPs tend to see standardized advance directives mainly as a tool to start a conversation with their patients and to identify their real preferences and values. When the patient is still not facing the progression of an already existing disease it could be sufficient to only appoint a surrogate decision maker instead of creating a full AD. However, in all other situations, appointing a surrogate decision maker should be backed up by a written statement of a patient's general values. Patients and their relatives should always have the opportunity to ask their GP for medical advice when drafting an AD. It is crucial to regularly verify and update existing ADs within the course of a disease.
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Affiliation(s)
- Ina Carola Otte
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
- Institute of Primary Health Care, University of Basel, Basel, Switzerland
| | - Bernice Elger
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Corinna Jung
- Institute of Primary Health Care, University of Basel, Basel, Switzerland
| | - Klaus Walter Bally
- Institute of Primary Health Care, University of Basel, Basel, Switzerland.
- Facharzt für Allgemeine Medizin FMH, Universitäres Zentrum für Hausarztmedizin beider Basel, St. Johanns-Parkweg 2, 4056, Basel, Switzerland.
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Konstantara E, Vandrevala T, Cox A, Creagh-Brown BC, Ogden J. Balancing professional tension and deciding upon the status of death: Making end-of-life decisions in intensive care units. Health Psychol Open 2016; 3:2055102915622928. [PMID: 28070383 PMCID: PMC5193261 DOI: 10.1177/2055102915622928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study investigated how intensivists make decisions regarding withholding and withdrawing treatment for patients at the end of their lives. This involved completing in-depth interviews from two sites of the South of England, United Kingdom by twelve intensivists. The data collected by these intensivists were analysed using thematic analysis. This resulted in the identification of three themes: intensivists' role, treatment effectiveness, and patients' best interest. Transcending these were two overarching themes relating to the balance between quantity and quality of life, and the intensivists' sense of responsibility versus burden. The results are considered in terms of making sense of death and the role of beliefs in the decision-making process.
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Do-not-resuscitate orders and related factors among family surrogates of patients in the emergency department. Support Care Cancer 2015; 24:1999-2006. [DOI: 10.1007/s00520-015-2971-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
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Oliver DJ, Borasio GD, Caraceni A, de Visser M, Grisold W, Lorenzl S, Veronese S, Voltz R. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. Eur J Neurol 2015; 23:30-8. [PMID: 26423203 DOI: 10.1111/ene.12889] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/10/2014] [Accepted: 09/02/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The European Association of Palliative Care Taskforce, in collaboration with the Scientific Panel on Palliative Care in Neurology of the European Federation of Neurological Societies (now the European Academy of Neurology), aimed to undertake a review of the literature to establish an evidence-based consensus for palliative and end of life care for patients with progressive neurological disease, and their families. METHODS A search of the literature yielded 942 articles on this area. These were reviewed by two investigators to determine the main areas and the subsections. A draft list of papers supporting the evidence for each area was circulated to the other authors in an iterative process leading to the agreed recommendations. RESULTS Overall there is limited evidence to support the recommendations but there is increasing evidence that palliative care and a multidisciplinary approach to care do lead to improved symptoms (Level B) and quality of life of patients and their families (Level C). The main areas in which consensus was found and recommendations could be made are in the early integration of palliative care (Level C), involvement of the wider multidisciplinary team (Level B), communication with patients and families including advance care planning (Level C), symptom management (Level B), end of life care (Level C), carer support and training (Level C), and education for all professionals involved in the care of these patients and families (Good Practice Point). CONCLUSIONS The care of patients with progressive neurological disease and their families continues to improve and develop. There is a pressing need for increased collaboration between neurology and palliative care.
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Affiliation(s)
- D J Oliver
- Palliative Medicine, Wisdom Hospice, Rochester, UK.,University of Kent, Kent, UK
| | - G D Borasio
- Service de soins palliatifs, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy.,European Palliative Care Research Center NTNU, Trondheim, Norway
| | - M de Visser
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria
| | - S Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - S Veronese
- Fondazione Assistenza e Ricerca in Oncologia, Turin, Italy
| | - R Voltz
- Department of Palliative Medicine, University Hospital, Cologne, Germany.,EAN Subspeciality Scientific Panel on Palliative Care, Vienna, Austria
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Shvartzman P, Reuven Y, Halperin M, Menahem S. Advance Directives-The Israeli Experience. J Pain Symptom Manage 2015; 49:1097-101. [PMID: 25637243 DOI: 10.1016/j.jpainsymman.2014.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 11/27/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT A major step in end-of-life care was achieved in December 2005 when the Israeli parliament passed the "Dying Patient Law." The law (§31-§36) allows a competent person, even if he/she is healthy, to leave written instructions known as advance medical directives (AD), in which they explain their wishes in detail with respect to future medical treatment should it be determined that they are an incompetent terminally ill patient, as defined by the provisions of that law. OBJECTIVES The aims were to characterize the group of individuals that completes ADs, characterize the content of recorded ADs, and analyze trends associated with them. METHODS We performed a cross-sectional study of the entire population that signed ADs in Israel from 2007 to September 2010. All computerized AD forms were retrieved from the Ministry of Health's database. A descriptive analysis of trends, characteristics, and authorized procedures relating to the population of AD signatories was done. RESULTS There was an increase in the number of ADs signed during the study period (1167 signatories). About 90% of the AD signatories were 65 years of age or older and 95% were healthy at the time they completed the AD. In an end-stage condition, the mean number of procedures declined was 16.6 ± 4.7 of 19. In a non-end-stage condition, the corresponding mean number was 12.7 ± 3.7 of 15. CONCLUSION There is a need to increase awareness in the general population of the option to prepare ADs. Family physicians, oncologists, and geriatricians should be more involved in this process.
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Affiliation(s)
- Pesach Shvartzman
- Department of Family Medicine and Palliative Care Unit, Clalit Health Services, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Palliative Clalit Health Services - Southern District Care Unit, Beer-Sheva, Israel.
| | - Yonatan Reuven
- Department of Family Medicine and Palliative Care Unit, Clalit Health Services, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Sasson Menahem
- Department of Family Medicine and Palliative Care Unit, Clalit Health Services, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Palliative Clalit Health Services - Southern District Care Unit, Beer-Sheva, Israel
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Oerlemans AJM, van Sluisveld N, van Leeuwen ESJ, Wollersheim H, Dekkers WJM, Zegers M. Ethical problems in intensive care unit admission and discharge decisions: a qualitative study among physicians and nurses in the Netherlands. BMC Med Ethics 2015; 16:9. [PMID: 25880418 PMCID: PMC4344998 DOI: 10.1186/s12910-015-0001-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/27/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with. METHODS This was an explorative, descriptive study using qualitative methods (individual and focus group interviews). We conducted 19 individual interviews and 4 focus group interviews with nurses and physicians working in the ICU or the general ward of 10 Dutch hospitals. RESULTS The ethical problems in the context of ICU admission and discharge can be divided into problems concerning full bed occupancy and problems related to treatment decisions. The gap between the high level of care the ICU can provide and the lower care level in the general ward sometimes leads to mutual misunderstandings. Our results indicate that when professionals of different wards feel there is a collective responsibility and effort to solve a problem, this helps to prevent or alleviate moral distress. ICU patients' wishes are often unknown, causing healthcare professionals to err on the side of more treatment. Additionally, the highly technological nature of intensive care appears to encourage over-treatment. CONCLUSIONS It is important for ICUs and general wards to communicate and cooperate well, since there is a mutual dependency for optimal patient flow between the different departments. Interventions that improve the understanding and cooperation between these wards may help mitigate ethical problems. The nature of the ICU environment makes it important for healthcare professionals to be aware of the risk of over-treatment, reflect on why they do what they do, and be mindful of a possible negative impact of over-treatment on their patients. Early discussion of a patient's wishes with regard to treatment options is important in preventing over-treatment.
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Affiliation(s)
- Anke J M Oerlemans
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Nelleke van Sluisveld
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Eric S J van Leeuwen
- Department of Intensive Care Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Hub Wollersheim
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Wim J M Dekkers
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Marieke Zegers
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
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Trarieux-Signol S, Moreau S, Gourin MP, Penot A, Edoux de Lafont G, Preux PM, Bordessoule D. Factors associated with the designation of a health care proxy and writing advance directives for patients suffering from haematological malignancies. BMC Palliat Care 2014; 13:57. [PMID: 25859160 PMCID: PMC4391307 DOI: 10.1186/1472-684x-13-57] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Abstract
Background During the last few decades, patients’ rights have been reinforced in many countries by acts of law. Measures now include health care proxies to uphold the doctor-patient relationship and advance directives for end-of-life patients. These could be relevant tools as early as the initial diagnosis of haematological malignancies because of the uncertain disease course. The aim of this research was to assess the factors associated with the designation of a proxy and writing advance directives by patients in a haematology department in France. Methods After a specific programme to encourage discussions about end-of-life preferences, we conducted a mixed-methods study comprising retrospective analysis of a random sample of 200 patients’ medical records, crossed with a qualitative analysis of the content of advance directives. Statistical analysis was performed by the RKward V 0.6.1 software with 0.05 denoting significance. The study was performed and presented in accordance with the STROBE guidelines. A thematic analysis of the advance directives was performed by two researchers. Results A total of 197 medical records were evaluable. The mean age of the patients was 66 years (range: 18–91). Nearly 2/3 of them (64.5%) designated a proxy, 6.1% wrote advance directives, and 8.1% and 4.6% expressed a wish to meet a religious representative or a volunteer, respectively. The 2-year survival rate was 78.4% [95%CI: 68.2-90.2]. Patients who wrote advance directives were statistically older (p <0.00025). Patients who wrote an advance directive were more likely to have expressed a wish to meet a religious representative (p <0.001) or a volunteer (p = 0.003). Marital status was a significant factor in appointing a proxy (p = 0.04). Conclusions To the best of our knowledge, this is the first paper to identify influencing factors for proxies and advance directives in a homogenous population of patients with haematological malignancies. Most patients chose a proxy. However, despite several training programmes for the carers and a care planning programme, few patients wrote advance directives. Our findings suggest that influencing factors are advanced age and a wish to see a religious representative. This study highlights the importance of oral communication about end-of-life issues between carers, patients and their relatives. Electronic supplementary material The online version of this article (doi:10.1186/1472-684X-13-57) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophie Trarieux-Signol
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Stéphane Moreau
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Marie-Pierre Gourin
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Amélie Penot
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Geoffroy Edoux de Lafont
- Centre Hospitalier Universitaire, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Pierre-Marie Preux
- Centre Hospitalier Universitaire, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Dominique Bordessoule
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
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Miyashita M, Kawakami S, Kato D, Yamashita H, Igaki H, Nakano K, Kuroda Y, Nakagawa K. The importance of good death components among cancer patients, the general population, oncologists, and oncology nurses in Japan: patients prefer "fighting against cancer". Support Care Cancer 2014; 23:103-10. [PMID: 24996829 DOI: 10.1007/s00520-014-2323-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/16/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND The objectives of this study were to compare the importance of components of a good death among cancer patients, the general population, oncologists, and oncology nurses, and explore which patients preferred "fighting against cancer." METHODS We conducted a cross-sectional anonymous self-reported survey of cancer patients who visited a radiation oncology outpatient clinic, oncologists, and oncology nurses at the Tokyo University Hospital and a random sample of the general population in the Tokyo metropolitan area. The outcomes were 18 previously developed components of a good death in Japanese cancer care consisting of 57 attributes. RESULTS Three hundred ten patients, 353 subjects from the general population, 109 oncologists, and 366 oncology nurses participated. The desire to "fight against cancer" was highly significantly different between patients and oncologists (effect size [ES] = -1.40; P = 0.001) and patients and oncology nurses (ES = -1.12; P = 0.001). "Physical and cognitive control" was, similarly, highly significantly different between patients and oncologists (ES = -1.30; P = 0.001) and patients and oncology nurses (ES = -1.06; P = 0.001). Patients who emphasized "maintaining hope and pleasure" (P = 0.0001), "unawareness of death" (P = 0.0001), and "good relationship with family" (P = 0.004) favored "fighting against cancer." The patients, however, who emphasized "physical and psychological comfort" did not significantly favor "fighting against cancer" (P = 0.004). CONCLUSION The importance of good death components differed between groups. Medical professionals should be aware of the diversity of values surrounding death and assess the patient's values and discuss them to support his or her quality of life. In addition, the development of care and a medical/social system to maintain hope and pleasure after failure of anticancer treatment is necessary.
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Affiliation(s)
- Mitsunori Miyashita
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,
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Characteristics and use of advance directives in a tertiary hospital. Period 2001-2011. Rev Clin Esp 2014; 214:296-302. [PMID: 24703989 DOI: 10.1016/j.rce.2014.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/15/2014] [Accepted: 02/20/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the characeristics of patients who provide written advance directives and their use in healthcare practice. METHODOLOGY Observational, descriptive, retrospective study of all written advance directives registered at a university hospital between 2001-2011. The clinical-demographic characteristics of the patients at the time they provided the documents was studied, as was as the later use of the documents through an electronic medical history analysis. RESULTS A total of 130 advance directive documents were registered. At the time of their provision, the average patient age was 61 years; some 64% were diagnosed with a neoplastic illness; 73% were completely independent (Barthel), and 36.4% presented no comorbidities (Charlson). The women were slightly older than the men (63 vs. 60, P=0.17), and they were more likely to provide advance directives (61.5% vs. 31.5%, P=0.01) than men; the womens' illnesses were less relevant (P=0.001), and the women presented less comorbidity (P=0.01). A total of 361 medical acts were reviewed (193 hospital admissions and 168 emergency visits). At the end of the study, 74 patients were alive (57%), 37 had died (28%), and in 19 cases (15%), their evolution was lost. Of those who died, 13 (35.1%) were functionally incapacitated in the terminal phase of their illness, and in 9 (69%), the advance directives were applied in the final phase of their illness. CONCLUSIONS The number of registered advance directives is low; they do not interfere in the care process, and the documents are considered in the final decisions of life.
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Comparison of timing and decision-makers of do-not-resuscitate orders between thoracic cancer and non-cancer respiratory disease patients dying in a Japanese acute care hospital. Support Care Cancer 2014; 22:1485-92. [PMID: 24414996 DOI: 10.1007/s00520-013-2105-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of the study was to compare timing and decision-makers of do-not-resuscitate (DNR) orders between patients with end-stage thoracic cancer and non-cancer respiratory diseases in a Japanese acute care hospital. METHODS This study retrospectively reviewed the medical records of patients who died between January 2008 and March 2013 in the Department of Respiratory Medicine of Osaka Police Hospital, a teaching and acute care hospital. We compared the decision-making process, especially timing and decision-maker, of DNR orders between patients with thoracic cancer and patients with non-cancer respiratory diseases. RESULTS There were 300 cancer patients and 147 non-cancer patients. Cancer patients were significantly younger, were hospitalized more frequently and for longer, were more likely to have a DNR order placed earlier and decided in advance of last admission, and were more likely to have normal cognitive function at the time of the DNR order than non-cancer patients. Spouses of cancer patients were more likely to participate in DNR discussion. Only approximately 6 % of patients participated in DNR discussion in both groups. Cancer patients less frequently received aggressive treatment at the end of life (EOL) and were more likely to die in general wards than in intensive care units. CONCLUSIONS Our study found that most Japanese patients, with or without cancer, who died in an acute care respiratory department, were not included in DNR discussions and that familial surrogates usually made the DNR decision at the EOL.
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Larkin C, Searight HR. A Systematic Review of Cultural Preferences for Receiving Medical “Bad News” in the United States. Health (London) 2014. [DOI: 10.4236/health.2014.616251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nakazawa K, Kizawa Y, Maeno T, Takayashiki A, Abe Y, Hamano J, Maeno T. Palliative Care Physicians’ Practices and Attitudes Regarding Advance Care Planning in Palliative Care Units in Japan. Am J Hosp Palliat Care 2013; 31:699-709. [DOI: 10.1177/1049909113507328] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To clarify physicians’ practices and attitudes regarding advance care planning (ACP) in palliative care units (PCUs) in Japan, we conducted a self-completed questionnaire survey of 203 certificated PCUs in 2010. Ninety-nine physicians participated in the survey. Although most Japanese palliative care physicians recognized the importance of ACP, many failed to implement aspects of patient-directed ACP that they acknowledged to be important, such as recommending completion of advance directives (ADs), designation of health care proxies, and implementing existing ADs. The physicians’ general preference for family-centered decision making and their feelings of difficulty and low confidence regarding ACP most likely underlie these results. The discrepancy between physicians’ practices and their recognition of the importance of ACP suggests an opportunity to improve end-of-life care.
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Affiliation(s)
- Kazuhiro Nakazawa
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takami Maeno
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ayumi Takayashiki
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Abe
- Department of Palliative Care, Asahikawa Medical University, Asahikawa, Japan
| | - Jun Hamano
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
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McMahan RD, Knight SJ, Fried TR, Sudore RL. Advance care planning beyond advance directives: perspectives from patients and surrogates. J Pain Symptom Manage 2013; 46. [PMID: 23200188 PMCID: PMC4111444 DOI: 10.1016/j.jpainsymman.2012.09.006] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CONTEXT Advance care planning (ACP) has focused on documenting life-sustaining treatment preferences in advance directives (ADs). The ADs alone may be insufficient to prepare diverse patients and surrogates for complex medical decisions. OBJECTIVES To understand what steps best prepare patients and surrogates for decision making. METHODS We conducted 13 English/Spanish focus groups with participants from a Veterans Affairs and county hospital and the community. Seven groups included patients (n=38), aged ≥65 years, who reported making serious medical decisions. Six separate groups included surrogates (n=31), aged ≥18 years, who made decisions for others. Semistructured focus groups asked what activities best prepared the participants for decision making. Two investigators independently coded data and performed thematic content analysis. Disputes were resolved by consensus. RESULTS The mean±SD patient age was 78±8 years, and 61% were nonwhite. The mean±SD surrogate age was 57±10 years, and 91% were nonwhite. Qualitative analysis identified four overarching themes about how to best prepare for decision making: 1) identify values based on past experiences and quality of life, 2) choose surrogates wisely and verify that they understand their role, 3) decide whether to grant leeway in surrogate decision making, and 4) inform other family and friends of one's wishes to prevent conflict. CONCLUSION Beyond ADs, patients and surrogates recommend several additional steps to prepare for medical decision making including using past experiences to identify values, verifying that the surrogate understands their role, deciding whether to grant surrogates leeway, and informing other family and friends of one's wishes. Future ACP interventions should consider incorporating these additional ACP activities.
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Affiliation(s)
- Ryan D McMahan
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, California, USA
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Yamaguchi M, Suzuki M. Independent living with Duchenne muscular dystrophy and home mechanical ventilation in areas of Japan with insufficient national welfare services. Int J Qual Stud Health Well-being 2013; 8:20914. [PMID: 23981723 PMCID: PMC3755181 DOI: 10.3402/qhw.v8i0.20914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2013] [Indexed: 11/24/2022] Open
Abstract
In Japan, there is no national 24-hour home care system for people with severe impairments. Despite this fact, a small number of people with Duchenne muscular dystrophy on home mechanical ventilation pursue independent living. Therefore, our aim was to better understand the process by which these individuals arrived at this goal for independence (i.e., choosing to live at home in Japan instead of in special sanatoriums that provide sufficient support and care). Twenty-one participants were interviewed in 2011 and 2013. The interviews were recorded, transcribed, and analysed following a grounded theory approach. These individuals placed particular emphasis on their personal choice regarding where and how they live as well as on whom they depend. Therefore, the core element underlying participants’ goals for independent living was self-reliant independency. To improve their social inclusion, the strategies used by the participants to retain their autonomy in an underdeveloped Japanese welfare system by establishing relationships with people in their communities can prevent them from experiencing social isolation. This could serve as an example to their counterparts in other countries.
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Affiliation(s)
- Miku Yamaguchi
- Division of Human Health Sciences, Department of Nursing, Graduate School of Medicine, Kyoto University, Kyoto Prefecture, Japan.
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Evans N, Pasman HR, Vega Alonso T, Van den Block L, Miccinesi G, Van Casteren V, Donker G, Bertolissi S, Zurriaga O, Deliens L, Onwuteaka-Philipsen B. End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. PLoS One 2013; 8:e57965. [PMID: 23472122 PMCID: PMC3589464 DOI: 10.1371/journal.pone.0057965] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Making treatment decisions in anticipation of possible future incapacity is an important part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment discussions and patients' appointment of surrogate decision-makers in Italy, Spain, Belgium and the Netherlands and examines associated factors. METHODS A cross-sectional, retrospective survey was conducted with representative GP networks in four countries. GPs recorded the health and care characteristics in the last three months of life of 4,396 patients who died non-suddenly. Prevalences were estimated and logistic regressions were used to examine between country differences and country-specific associated patient and care factors. RESULTS GP-patient discussion of treatment preferences occurred for 10%, 7%, 25% and 47% of Italian, Spanish, Belgian and of Dutch patients respectively. Furthermore, 6%, 5%, 16% and 29% of Italian, Spanish, Belgian and Dutch patients had a surrogate decision-maker. Despite some country-specific differences, previous GP-patient discussion of primary diagnosis, more frequent GP contact, GP provision of palliative care, the importance of palliative care as a treatment aim and place of death were positively associated with preference discussions or surrogate appointments. A diagnosis of dementia was negatively associated with preference discussions and surrogate appointments. CONCLUSIONS The study revealed a higher prevalence of treatment preference discussions and surrogate appointments in the two northern compared to the two southern European countries. Factors associated with preference discussions and surrogate appointments suggest that delaying diagnosis discussions impedes anticipatory planning, whereas early preference discussions, particularly for dementia patients, and the provision of palliative care encourage participation.
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Affiliation(s)
- Natalie Evans
- Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
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Bellamy G, Gott M. What are the priorities for developing culturally appropriate palliative and end-of-life care for older people? The views of healthcare staff working in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:26-34. [PMID: 22812427 DOI: 10.1111/j.1365-2524.2012.01083.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper explores the views of healthcare staff regarding the provision of culturally appropriate palliative care for Māori, Pacific Island and Chinese elders living in Auckland, New Zealand. The ageing population is culturally and ethnically diverse and, along with other developed countries experiencing high levels of migration, the challenge is balancing the rise in numbers of older people from different ethnic and cultural groups with end-of-life care, which reflects personal values and beliefs. Two joint interviews and ten focus groups were conducted with eighty staff across a range of primary, secondary and speciality care settings in 2010. The findings demonstrated that participants viewed the involvement of family as fundamental to the provision of palliative care for Māori, Pacific Island and Chinese elders. For Māori and Pacific Islanders, healthcare staff indicated the importance of enabling family members to provide 'hands-on' care. The role of family in decision-making was fundamental to the delivery of and satisfaction with care for older Chinese family members. Care staff highlighted the need to be cognisant of individual preferences both within and across cultures as a fundamental aspect of palliative care provision. The role of family in 'hands-on' palliative care and decision-making requires care staff to relinquish their role as 'expert provider'. Counter to the prioritisation of autonomy in Western health-care, collective decision-making was favoured by Chinese elders. Providing families with the requisite knowledge and skills to give care to older family members was important. Whilst assumptions are sometimes made about preferences for end-of-life care based on cultural values alone, these data suggest that care preferences need to be ascertained by working with family members on an individual basis and in a manner that respects their involvement in palliative care provision.
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Affiliation(s)
- Gary Bellamy
- School of Nursing, The University of Auckland, New Zealand.
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Kizawa Y, Tsuneto S, Hamano J, Nagaoka H, Maeno T, Shima Y. Advance Directives and Do-Not-Resuscitate Orders Among Patients With Terminal Cancer in Palliative Care Units in Japan. Am J Hosp Palliat Care 2012; 30:664-9. [DOI: 10.1177/1049909112462860] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the current status of advance directives (ADs) and do-not-resuscitate (DNR) orders among patients with terminal cancer in palliative care units (PCUs) in Japan. Methods: We conducted a retrospective chart review of the last 3 consecutive patients who died in 203 PCUs before November 30, 2010. Results: The percentages of patients who had ADs during the final hospitalization for cardiopulmonary resuscitation, mechanical ventilation, intravenous fluid administration, tube feeding, antibiotic administration, and who had appointed a health care proxy were 47%, 46%, 42%, 19%, 18%, and 48%, respectively. Seventy-six percent of the patients had a DNR order. Of the patients with decision-making capacity, 68% were involved in the DNR decision. Conclusions: These findings may reflect positive changes in patients’ attitudes toward ADs, in Japan.
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Affiliation(s)
- Yoshiyuki Kizawa
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Hiroka Nagaoka
- Center for Palliative and Supportive Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Takami Maeno
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
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Evans N, Bausewein C, Meñaca A, Andrew EVW, Higginson IJ, Harding R, Pool R, Gysels M. A critical review of advance directives in Germany: attitudes, use and healthcare professionals' compliance. PATIENT EDUCATION AND COUNSELING 2012; 87:277-288. [PMID: 22115975 DOI: 10.1016/j.pec.2011.10.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/05/2011] [Accepted: 10/22/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Recent legal changes in Germany make non-compliance with advance directives (ADs) a criminal offence. This article assesses the evidence on attitudes towards, use of, and physician compliance with ADs in Germany. METHODS Critical review: studies on ADs, identified from a systematic review of culture and end-of-life care in Germany (11 electronic databases, 3 journals, reference lists, and grey literature), were included. An interpretative synthesis of findings revealed cross-cutting themes. RESULTS Thirty-two studies (1996-2009) were identified. Key themes were: awareness; utilization; compliance; and bindingness of ADs. There was a positive trend between awareness of ADs and study publication date. Use varied between patient groups (0.3-62%) and was low amongst the general population (2.5-10%). Fears about ADs' purpose and possible abuse were identified. Physician discomfort in discussing ADs and non-compliance were reported. Physicians preferred legally binding ADs, though conflicting results were reported for patients' desired level of bindingness. CONCLUSION Although there is increasing awareness of ADs in Germany, there remains low use, poor communication, fears of abuse, some non-compliance and contradictory evidence regarding desired bindingness. PRACTICAL IMPLICATIONS Although legal changes will hopefully improve compliance, low awareness, communication difficulties and uncertainties surrounding ADs must be addressed if use is to increase.
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Affiliation(s)
- Natalie Evans
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - Universitat de Barcelona), Barcelona, Spain.
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Koffman J, Morgan M, Edmonds P, Speck P, Siegert R, Higginson IJ. Meanings of happiness among two ethnic groups living with advanced cancer in south London: a qualitative study. Psychooncology 2012; 22:1096-103. [DOI: 10.1002/pon.3108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/24/2012] [Accepted: 04/24/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan Koffman
- King's College London; Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation; UK
| | - Myfanwy Morgan
- King's College London; Department of Public Health Sciences; UK
| | - Polly Edmonds
- King's College London; Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation; UK
| | - Peter Speck
- King's College London; Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation; UK
| | - Richard Siegert
- King's College London; Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation; UK
| | - Irene J. Higginson
- King's College London; Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation; UK
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