Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Am Geriatr Soc. 2024 Oct;72(10):3171-3178. doi: 10.1111/jgs.19040. Epub 2024 Jun 19.
The population of people living with dementia (PLwD) continues to grow in Japan where advance care planning (ACP) for PLwD is relatively new. Our aim was to evaluate the feasibility and cultural acceptability of a dementia-specific ACP communication skills toolkit for Japanese primary care clinicians.
We delivered 13 training sessions in primary care clinics across central Japan and conducted a post-training survey to assess whether the toolkit increased confidence in dementia-specific ACP communication skills and the acceptability of the toolkit with the following four statements: (1) The language in the sessions was clear, (2) The sessions took an appropriate amount of time to complete, (3) The design of the sessions was an effective educational method, and (4) The sessions were culturally appropriate for communication with Japanese patients with dementia and their family members. We asked participants to respond using a 5-point Likert scale from strongly agree to strongly disagree.
All participants were Japanese and included 80 physicians (mean age 39.8 years), 33 nurses (mean age 45.7 years), and 58 other participants (mean age 42.9 years), who were 30.0%, 87.9%, and 55.2% female, respectively. Most participants practiced in rural settings. In pre- post-comparisons, participant confidence increased in determining capacity, understanding dementia prognosis, goals of care, eliciting surrogates, recommending self-care practices to families, and leading family meetings (all p < 0.001). Most participants strongly agreed or agreed that the toolkit was an effective method (96.9%), took an appropriate amount of time (94.5%), contained clear language (89.8%), and was culturally appropriate (73.6%).
Dementia-specific ACP communication skills toolkit can be delivered in Japan. Japanese primary care clinicians generally felt the dementia-specific ACP toolkit increased their confidence in ACP communication skills and was acceptable. The language, time, and design were well received, though further work is needed to improve the cultural appropriateness of the toolkit.
在日本，患有痴呆症的人口（PLwD）持续增长，而针对 PLwD 的预先护理计划（ACP）相对较新。我们的目的是评估针对日本初级保健临床医生的特定于痴呆症的 ACP 沟通技巧工具包的可行性和文化可接受性。
我们在日本中部的多家初级保健诊所进行了 13 次培训课程，并在培训后进行了调查，以评估工具包是否可以提高对特定于痴呆症的 ACP 沟通技巧的信心，以及对以下四个陈述的工具包的可接受性：（1）课程中的语言清晰易懂，（2）课程完成时间适当，（3）课程设计是一种有效的教育方法，（4）课程在与日本痴呆症患者及其家庭成员进行沟通方面具有文化适宜性。我们要求参与者使用 5 点李克特量表从非常同意到非常不同意进行回答。
所有参与者均为日本人，包括 80 名医生（平均年龄 39.8 岁），33 名护士（平均年龄 45.7 岁）和 58 名其他参与者（平均年龄 42.9 岁），分别为 30.0％，87.9％和 55.2％的女性。大多数参与者在农村地区执业。在前后比较中，参与者在确定能力，了解痴呆症预后，护理目标，引出代理人，向家属推荐自我护理实践以及领导家庭会议方面的信心均有所提高（均 p<0.001）。大多数参与者强烈同意或同意工具包是一种有效的方法（96.9％），花费了适当的时间（94.5％），语言清晰易懂（89.8％），并且具有文化适宜性（73.6％）。
可以在日本提供特定于痴呆症的 ACP 沟通技巧工具包。日本初级保健临床医生普遍认为，特定于痴呆症的 ACP 工具包增加了他们对 ACP 沟通技巧的信心，并且可以接受。语言，时间和设计都受到好评，但仍需要进一步努力来提高工具包的文化适宜性。
