Groenewoud A Stef, Sasaki Noriko, Westert Gert P, Imanaka Yuichi
Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Healthcare Economics and Quality Management, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
Medicine (Baltimore). 2020 Oct 30;99(44):e22743. doi: 10.1097/MD.0000000000022743.
Strategies to increase appropriateness of EoL care, such as shared decision making (SDM), and advance care planning (ACP) are internationally embraced, especially since the COVID-19 pandemic. However, individuals preferences regarding EoL care may differ internationally. Current literature lacks insight in how preferences in EoL care differ between countries and continents. This study's aim is to compare Dutch and Japanese general publics attitudes and preferences toward EoL care, and EoL decisions. Methods: a cross-sectional survey design was chosen. The survey was held among samples of the Dutch and Japanese general public, using a Nationwide social research panel of 220.000 registrants in the Netherlands and 1.200.000 in Japan. A quota sampling was done (age, gender, and living area). N = 1.040 in each country.More Japanese than Dutch citizens tend to avoid thinking in advance about future situations of dependence (26.0% vs 9.4%; P = .000); say they would feel themselves a burden for relatives if they would become dependent in their last phase of life (79.3% vs 47.8%; P = .000); and choose the hospital as their preferred place of death (19.4% vs 3.6% P = .000). More Dutch than Japanese people say they would be happy with a proactive approach of their doctor regarding EoL issues (78.0% vs 65.1% JPN; P = .000).Preferences in EoL care substantially differ between the Netherlands and Japan. These differences should be taken into account a) when interpreting geographical variation in EoL care, and b) if strategies such as SDM or ACP - are considered. Such strategies will fail if an international "one size fits all" approach would be followed.
提高临终关怀适宜性的策略，如共同决策（SDM）和预先护理计划（ACP），在国际上受到广泛认可，尤其是自新冠疫情以来。然而，不同国家的个人对临终关怀的偏好可能存在差异。目前的文献缺乏对不同国家和大陆在临终关怀偏好方面差异的深入了解。本研究的目的是比较荷兰和日本普通公众对临终关怀的态度、偏好以及临终决策。方法：采用横断面调查设计。该调查在荷兰和日本普通公众样本中进行，荷兰使用了一个有22万登记人的全国性社会研究小组，日本使用了一个有120万登记人的小组。采用配额抽样（按年龄、性别和居住地区）。每个国家的样本量为N = 1040。与荷兰公民相比，更多的日本公民倾向于避免提前思考未来依赖的情况（26.0%对9.4%；P = 0.000）；表示如果在生命的最后阶段变得依赖，会觉得自己是亲属的负担（79.3%对47.8%；P = 0.000）；并选择医院作为他们首选的死亡地点（19.4%对3.6%，P = 0.000）。与日本人相比，更多的荷兰人表示他们会对医生在临终问题上采取积极主动的态度感到满意（78.0%对65.1%，日本；P = 0.000）。荷兰和日本在临终关怀偏好上存在显著差异。在a）解释临终关怀的地理差异时，以及b）考虑共同决策或预先护理计划等策略时，应考虑这些差异。如果采用国际通用的“一刀切”方法，这些策略将会失败。
