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.
J Gen Intern Med. 2021 Oct;36(10):2935-2942. doi: 10.1007/s11606-020-06524-4. Epub 2021 Feb 5.
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.
To identify healthcare providers' willingness to initiate advance care planning discussions in Japan.
A mixed-methods questionnaire comprising three case scenarios based on three different illness trajectories.
The study participants were physicians and nurses employed in four community hospitals in Japan.
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.
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.
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.
大多数成年患者都愿意在任何疾病发作之前讨论预先护理计划。在医疗保健提供者与患者开始预先护理计划讨论的时间偏好方面，可能存在差异。
确定日本医疗保健提供者启动预先护理计划讨论的意愿。
一项基于三种不同疾病轨迹的三种病例情景的混合方法问卷。
该研究的参与者是日本四家社区医院的医生和护士。
定量确定了在患者疾病轨迹的四个阶段，医生和护士启动预先护理计划讨论的意愿百分比，并定性确定了对首选时间的看法。
从 108 名医生和 123 名护士（应答率：99%）中，获得了三个病例情景的 291 名医生和 362 名护士的 362 名护士的答复。总体而言，51.2%的医生和 65.5%的护士（p < 0.001）接受了在患病前进行讨论。不到三分之一的医生认为预先护理计划是“明智的预防措施”，而大约三分之二的护士则认为是这样。此外，超过一半的医生和护士都希望将预先护理计划推迟到患者即将死亡时。
尽管大多数人更愿意等到患者接近死亡时，但是与护士相比，医生不太愿意在患者健康状况恶化之前开始预先护理计划讨论。需要解决医疗保健提供者对预先护理计划的态度，以提高日本的完成率。
