Healthcare Providers' Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study
Healthcare Providers' Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study
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DOI：
10.1007/s11606-020-06524-4
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发表时间：
2021-02-05
影响因子：
5.7
通讯作者：
Yamamoto, Yosuke
中科院分区：
文献类型：
--
作者：
Miyashita, Jun;Kohno, Ayako;Yamamoto, Yosuke
背景大多数成人患者愿意在任何疾病发生前讨论提前护理计划。当涉及到发起医疗保健提供者与患者的高级护理计划讨论时，可能会在时机上有不同的偏好。目的了解医疗服务提供者是否愿意在日本发起提前护理计划讨论。设计一份混合方法问卷，包括基于三种不同疾病轨迹的三种病例情景。参与者研究参与者是在日本四家社区医院工作的医生和护士。主要测量指标医生和护士愿意在患者病情轨迹的四个阶段发起提前护理计划讨论的百分比被定量确定，并定性地确定了对首选时机的看法。主要结果来自108名医生和123名护士受访者(应答率：99%)，291名医生和362名护士关于三个案例情景的回复。总体而言，51.2%的医生和65.5%的护士(P<；0.001)在病前接受讨论。不到三分之一的医生认为提前护理计划是“明智的预防措施”，而大约三分之二的护士这样认为。此外，超过一半的医生和护士都倾向于将提前护理计划推迟到患者即将死亡时。结论医生比护士更不愿意在患者健康恶化之前开始提前护理计划讨论，但大多数医生倾向于等到患者濒临死亡时再讨论。医疗保健提供者对提前护理计划的态度将需要得到解决，以提高日本的完成率。
Background Most adult patients are willing to discuss advance care planning before the onset of any illness. There might be differences in preferences for timing when it comes to initiating advance care planning discussions by healthcare providers with patients. Objective To identify healthcare providers' willingness to initiate advance care planning discussions in Japan. Design A mixed-methods questionnaire comprising three case scenarios based on three different illness trajectories. Participants The study participants were physicians and nurses employed in four community hospitals in Japan. Main Measures Percentages of physicians' and nurses' willingness to initiate advance care planning discussions at four stages of patients' illness trajectory were quantitatively determined, and perceptions on preferred timing were qualitatively identified. Key Results From 108 physician and 123 nurse respondents (response rate: 99%), 291 physician and 362 nurse responses about three case scenarios were obtained. Overall, 51.2% of physicians and 65.5% of nurses (p < 0.001) accepted discussion before illness. Less than one-third of physicians considered advance care planning a "wise precaution," while about two-thirds of nurses did. Additionally, more than half of both physicians and nurses preferred to postpone advance care planning until the patient's imminent death. Conclusions Physicians are less willing than nurses to begin advance care planning discussions before patients' health has deteriorated though most prefer to wait until the patients are close to death. Healthcare providers' attitudes toward advance care planning will need to be addressed to improve rates of completion in Japan.