Tanimoto Mariko, Okamura Norihiro, Sawada Kaku, Igarashi Tomofumi, Nishikawa Mitsunori
Department of Nursing, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan.
Medical Social Worker, Keiwakai Nishioka Hospital, Hokkaido, Japan.
PLoS One. 2025 May 28;20(5):e0323976. doi: 10.1371/journal.pone.0323976. eCollection 2025.
Globally, multi-disciplinary advance care planning (ACP) in multi-facility settings for aging communities is essential; however, it does not consistently yield the desired outcomes. Japan's population is rapidly aging; nonetheless, no studies have examined comprehensive ACP implementation by diverse professionals across various community healthcare facilities. Within the context of an aging community, this study aimed to identify the barriers and facilitators to ACP implementation by multiple professionals in various healthcare facilities. A qualitative research design was employed. The study participants included 22 multidisciplinary members of a community-based palliative care (CBPC) team. Individual semi-structured interviews were conducted between September and October 2019. A total of 19 barriers and 19 facilitators were identified and categorized into seven practice domains: "Understanding patients' intentions," "Family support," "Information sharing using tools," "Collaboration among multiple professions," "Cross-facility and cross-departmental cooperation," "Raising awareness in the community," and "Efforts by implementation promoters and their departments." Barriers included "Inability to understand the patient's intentions," "Physical and psychological distance between patient and family," and "Different information needs and sharing methods at each facility," among others. Facilitators included "Skills for better understanding the true meaning of patients' intentions," "Compatibility of daily tasks and ACP by utilizing tools," "Human connections between professionals in multiple facilities and departments," and "Engagement with ACP implementation," among others. The study identified important domains for practical ACP implementation using a community-based palliative care team collaborating across multiple community facilities, as well as the barriers and facilitators. The findings indicate that multi-disciplinary, multi-facility ACP implementation in regions with aging populations requires establishing a regional collaborative network system and a human network. Healthcare professionals must develop practical ACP experience to identify its benefits while enhancing their skills as "advocates."
在全球范围内，针对老龄化社区的多设施环境开展多学科的预立医疗计划（ACP）至关重要；然而，它并不能始终产生预期的效果。日本人口正在迅速老龄化；尽管如此，尚无研究考察不同社区医疗机构中各类专业人员对ACP的全面实施情况。在老龄化社区的背景下，本研究旨在确定各类医疗机构中多名专业人员实施ACP的障碍和促进因素。采用了定性研究设计。研究参与者包括一个社区姑息治疗（CBPC）团队的22名多学科成员。在2019年9月至10月期间进行了个人半结构化访谈。共识别出19个障碍和19个促进因素，并将其分为七个实践领域：“了解患者意图”、“家庭支持”、“使用工具进行信息共享”、“多专业协作”、“跨机构和跨部门合作”、“提高社区意识”以及“实施推动者及其部门的努力”。障碍包括“无法理解患者意图”、“患者与家庭之间的身心距离”以及“各机构不同的信息需求和共享方法”等。促进因素包括“更好理解患者意图真正含义的技能”、“通过利用工具使日常任务与ACP兼容”、“多个机构和部门专业人员之间的人际关系”以及“参与ACP实施”等。该研究确定了利用跨多个社区设施合作的社区姑息治疗团队进行实际ACP实施的重要领域，以及障碍和促进因素。研究结果表明，在老龄化地区实施多学科、多设施的ACP需要建立区域协作网络系统和人际网络。医疗保健专业人员必须积累实际的ACP经验以认识到其益处，同时提升作为“倡导者”的技能。
