Tanaka Masashi, Bito Seiji, Enzo Aya, Okita Takethoshi, Atsushi Asai
Department of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Seiryotyou, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
BMC Med Ethics. 2021 Sep 24;22(1):128. doi: 10.1186/s12910-021-00698-0.
Instances of surrogate decision-making are expected to increase with the rise in hospitalised older adults in Japan. Few large-scale studies have comprehensively examined the entire surrogate decision-making process. This study aimed to gather information to assess the current state of surrogate decision-making in Japan.
A cross-sectional survey was conducted using online questionnaires. A total of 1000 surrogate decision-makers responded to the questionnaire. We examined the characteristics of surrogate decision-makers and patients, content of surrogate decision-making meeting regarding life-sustaining treatment between the doctors and surrogate decision-makers, extent of involvement of the various parties in the surrogate decision-making process, judgement grounds for surrogate decision-making, and frequency of involvement in the surrogate decision-making process.
Of the participants, 70.5% were male and 48.3% were eldest sons. Only 7.6% of the patients had left a written record of their preferences and 48.8% of the surrogates reported no knowledge of the patient having expressed their prior intentions regarding medical care in any form. Respondents indicated that their family meetings with healthcare professionals mostly included the information recommended by guidelines in a surrogate decision-making meeting in Japan. Most participants reported a good understanding of the meeting content. Although many participants based their decisions on multiple grounds, surrogates' considerations may not adequately reflect respect for patient autonomy in Japan. Specifically, the eldest son considered his own preference more frequently than that of the other surrogate decision-makers. In 26.1% of the cases, either zero or one family meeting with healthcare professionals was held. In these cases, significantly fewer decisions involved the participation of healthcare professionals other than the doctor compared to cases with multiple meetings.
Surrogate decisions in Japan are most commonly made by eldest sons and may not frequently consider the perspectives of other surrogates. The finding that patient preferences were rarely known suggests a role for increased advance care planning.
随着日本住院老年人数量的增加，代行决策的情况预计也会增多。很少有大规模研究全面考察整个代行决策过程。本研究旨在收集信息以评估日本代行决策的现状。
采用在线问卷进行横断面调查。共有1000名代行决策者回复了问卷。我们考察了代行决策者和患者的特征、医生与代行决策者之间关于维持生命治疗的代行决策会议内容、各方在代行决策过程中的参与程度、代行决策的判断依据以及参与代行决策过程的频率。
参与者中，70.5%为男性，48.3%为长子。只有7.6%的患者留下了偏好的书面记录，48.8%的代行决策者表示不知道患者曾以任何形式表达过对医疗护理的事先意愿。受访者表示，他们与医疗保健专业人员的家庭会议大多包含日本代行决策会议指南所推荐的信息。大多数参与者表示对会议内容理解良好。尽管许多参与者基于多种依据做出决策，但在日本，代行决策者的考虑可能没有充分体现对患者自主权的尊重。具体而言，长子比其他代行决策者更频繁地考虑自己的偏好。在26.1%的案例中，与医疗保健专业人员举行的家庭会议为零次或仅一次。在这些案例中，与多次会议的案例相比，涉及医生以外其他医疗保健专业人员参与的决策明显更少。
在日本，代行决策最常由长子做出，可能不常考虑其他代行决策者的观点。患者偏好很少为人所知这一发现表明加强预先护理计划具有重要作用。
