Miyashita Jun, Kohno Ayako, Cheng Shao-Yi, Hsu Su-Hsuan, Yamamoto Yosuke, Shimizu Sayaka, Huang Wei-Sheng, Kashiwazaki Motohiro, Kamihiro Noriki, Okawa Kaoru, Fujisaki Masami, Tsai Jaw-Shiun, Fukuhara Shunichi
Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Palliat Med. 2020 Jul;34(7):906-916. doi: 10.1177/0269216320914791. Epub 2020 May 1.
Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain.
To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan.
Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing.
SETTING/PARTICIPANTS: Patients aged 40-75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited.
Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan ( < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers' initiative.
The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients' preferences and factors associated with acceptance and reluctance to initiate advance care planning.
尽管预先护理计划讨论在全球范围内越来越被接受，但其理想时机尚不确定，且可能涉及文化因素。
评估日本和台湾地区成年患者开始预先护理计划讨论的时机及影响因素。
采用混合方法问卷调查，定量确定在从健康到病情严重的疾病轨迹四个阶段中愿意开始预先护理计划讨论的患者百分比，并确定偏好时机背后的定性认知。
地点/参与者：随机招募了日本四家医院和台湾两家医院门诊就诊的40 - 75岁患者。
总体而言（700名受访者中），日本365名受访者中有72%，台湾335名受访者中有84%（<0.001）接受在患病前进行讨论。在日本，患病前愿意讨论的相关因素是年龄较小和拒绝维持生命治疗；在台湾，相关因素是年龄较大、社会支持较强和拒绝维持生命治疗。提取了四类主要态度：最常见的是将讨论视为明智的预防措施，这一类别的回答数量超过了推迟讨论直至生命即将结束的偏好、接受死亡的普遍必然性以及偏好由医疗服务提供者主动发起讨论。
大多数患者愿意在健康严重受损之前开始讨论；约五分之一的患者直到明确面临死亡才愿意开始。为促进预先护理计划，医疗服务提供者必须留意患者的偏好以及与接受和不愿开始预先护理计划相关的因素。
