Patients’ preferences and factors influencing initial advance care planning discussions’ timing: A cross-cultural mixed-methods study
Journal
Palliative Medicine
Journal Volume
34
Journal Issue
7
Pages
906-916
Date Issued
2020
Author(s)
Miyashita J.
Kohno A.
Hsu S.-H.
Yamamoto Y.
Shimizu S.
Huang W.-S.
Kashiwazaki M.
Kamihiro N.
Okawa K.
Fujisaki M.
Fukuhara S.
Abstract
Background: Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain. Aim: To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan. Design: Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing. Setting/participants: Patients aged 40–75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited. Results: Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan (p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers’ initiative. Conclusion: The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients’ preferences and factors associated with acceptance and reluctance to initiate advance care planning. ? The Author(s) 2020.
SDGs
Other Subjects
adult; advance care planning; aged; Article; caregiver; doctor patient relationship; family medicine; health care personnel; health personnel attitude; heart rehabilitation; human; illness trajectory; Japan; major clinical study; mini international neuropsychiatric interview; mitral valve surgery; mouth hygiene; outcome assessment; palliative therapy; patient preference; physical activity; prevalence; questionnaire; scoring system; social support; Taiwan; terminal care; terminally ill patient; walking speed; cultural factor; Japan; middle aged; patient preference; Taiwan; terminal care; Adult; Advance Care Planning; Aged; Cross-Cultural Comparison; Humans; Japan; Middle Aged; Patient Preference; Taiwan; Terminal Care
Publisher
SAGE Publications Ltd
Type
journal article