Oku Medical Clinic, Osaka, Japan.
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
Clin Exp Nephrol. 2024 Jun;28(6):571-580. doi: 10.1007/s10157-024-02458-x. Epub 2024 Feb 25.
The majority of dialysis patients and clinicians favor early advance care planning in our sample. Yet, there is a disconnect: only 11% of patients discussed future care with their clinicians. Our findings indicate Japanese dialysis patients and clinicians support proactive advance care planning at or before dialysis initiation.
Little is known about the optimal timing of discussions about advance care planning among dialysis patients and clinicians engaged in dialysis care. We aimed to explore the preferred timing for advance care planning and assess actual participation in advance care planning among dialysis patients and their clinicians.
A scenario-based survey on Japanese patients aged ≥65 years on dialysis and clinicians involved in their dialysis care was performed. Participants were asked if they would feel prepared to engage in advance care planning with their clinicians, offering a choice among four hypothetical stages within the illness trajectory, extending from the initiation of dialysis to a later phase characterized by the patient's extreme frailty.
Overall, 181 patients and 128 clinicians participated in the study. Among these, 131 (72%) patients, and 84 (66%) clinicians indicated that they would prefer to initiate advance care planning around the time of dialysis initiation. Only 20 patients (11%) indicated that they had participated in advance care planning with at least one clinician, including 11 (6%) who indicated that they had discussed their preferences around life-sustaining treatments and 8 (4%) who had discussed their preferences around dialysis continuation.
While fewer than 11% of patients undergoing dialysis and their clinicians enrolled in our study had participated in advance care planning, most indicated that they would be comfortable initiating the discussion around the time of dialysis initiation. These findings suggest untapped opportunities to engage patients in advance care planning early in the course of their dialysis.
在我们的样本中，大多数透析患者和临床医生都支持在透析前尽早进行预先护理计划。然而，存在脱节现象：只有 11%的患者与他们的临床医生讨论过未来的护理问题。我们的研究结果表明，日本透析患者和临床医生支持在透析开始前或开始时积极进行预先护理计划。
关于在接受透析治疗的透析患者和临床医生中，何时开始讨论预先护理计划的最佳时机知之甚少。我们旨在探讨预先护理计划的最佳时机，并评估透析患者及其临床医生实际参与预先护理计划的情况。
对年龄≥65 岁的日本透析患者和参与其透析治疗的临床医生进行了基于情景的调查。参与者被问到他们是否会感到有准备与他们的临床医生一起进行预先护理计划，并在疾病轨迹的四个假设阶段中做出选择，从开始透析到患者极度虚弱的后期阶段。
共有 181 名患者和 128 名临床医生参与了这项研究。在这些患者中，有 131 名（72%）患者和 84 名（66%）临床医生表示，他们希望在开始透析时开始预先护理计划。只有 20 名患者（11%）表示他们至少与一名临床医生一起参与了预先护理计划，其中 11 名（6%）表示他们已经讨论了维持生命治疗的偏好，8 名（4%）表示他们已经讨论了继续透析的偏好。
虽然在接受透析治疗的患者及其临床医生中，参与预先护理计划的患者不到 11%，但大多数人表示他们愿意在开始透析时开始讨论。这些发现表明，在透析过程中尽早让患者参与预先护理计划的机会尚未得到充分利用。
