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

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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.