Tanaka Masashi, Ohnishi Kayoko, Enzo Aya, Okita Taketoshi, Asai Atsushi
Department of Medical Ethics, Tohoku University Graduate School of Medicine, Sendai, Japan.
Division of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
BMC Med Ethics. 2021 Jan 13;22(1):5. doi: 10.1186/s12910-020-00573-4.
In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements.
In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals.
A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker.
Surrogate decision-makers based their decisions on important aspects related to a patient's life, and they considered not only the patient's preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.
在未来几年，替代决策预计将在日本临床实践中高度普及。此外，最近促进预立医疗计划的活动有所增加，这可能会影响替代决策者的判断方式。本研究旨在阐明日本替代决策者做出判断的依据。
在这项定性研究中，进行了半结构化访谈，以考察急性护理医院中维持生命的关键治疗选择的替代决策中的判断依据。
共有228名参与者符合纳入标准，其中15人被选入访谈。我们对14份访谈记录的内容进行了定性分析，排除了一份不符合纳入标准的记录。基于此分析，我们提取了关于替代决策中判断依据的4个核心类别、17个类别、35个子类别和55个编码。四个核心类别如下：以患者偏好为导向的因素（类型1）、以患者利益为导向的因素（类型2）、以家庭偏好为导向的因素（类型3）以及平衡患者/家庭偏好为导向的因素（类型4）。类型4核心类别代表了平衡患者偏好与替代决策者偏好的尝试。
替代决策者基于与患者生命相关的重要方面做出决策，他们不仅考虑患者的偏好和最大利益，还考虑自身的偏好。由于未来替代决策的需求将会增加，决策者将需要从更多样化的角度考虑判断依据。
