Creating an advance directive model for Japanese elders to enhance the completion rate: Focusing on current changes in the family roles regarding decision-making in the end-of-life

大部分长者及其家人均认同预嘱的概念，并对完成预嘱持积极态度。当长者及其家人被归类为“良好家庭系统”时，他们的临终愿望大多符合。另一方面，当他们处于“坏家庭系统”中时，他们的愿望就不太可能相同。特别是当老人与家人对家庭制度的认知不一致时，他们的临终愿望会出现显著差异，而促进预嘱完成模式的五个主要因素分别为：年龄、家庭结构（谁最可靠）、家庭制度、对预嘱的认知和临终愿望。未来应积极利用预先指导的促进模式，并建立家庭系统评估工具，以协助长者作出临终照护决策。

Most elders and their family members agreed with the concept of advance directives and their attitude towards its completion was positive. When the elders and his/her family members were categorized in the“good family system”, their wishes for the end-of-life were mostly matched. On the other hand, when they were in “bad family system”, their wishes were unlikely the same. Especially, when the perception of the family system by the elders and their family members did not match, their wishes for the end-of-life became remarkably different.The five main elements of the model for promotion of advance directive completion were: age, family structure (who is the most reliable), family system, perception about advance directive, and wishes for the end-of-life. In the future, actively utilizing the advance directive promotion model and creating the family system assessment tool for end-of-life care decision-making by elders are essential.