第14回 Asia Pacific Hospice Palliative Care Conference

Concurrent Session 7 (CC7) “Advance care planning in the real world: Global perspectives”
Gap between patients’and healthcare providers’perceptions regarding the timing of initial advance care planning discussions in Japan
Jun Miyashita

Abstract
Japan is the most aged society in the world. By 2025, for the first time worldwide, more than 30% of the Japanese population will be aged 65 years and over. Therefore, advance care planning (ACP) discussions will be more essential for end-of-life care in older adults in Japan. The prevalence of ACP discussions doubled from the second half of the 2000s (approximately 20%) to the second half of the 2010s (approximately 40%). This may be attributed to the rapid growth in senior populations and increased interest in patient autonomy at the end of life. However, these numbers are still lower than those in the USA and Canada. Therefore, to promote ACP, it is important to identify and understand factors facilitating and impeding ACP in Japan. A nationwide survey in Japan reported that about half of the physicians working in palliative care units were not actively involved in the ACP process, despite the general population in Japan being inclined to receive information about end-of-life care from healthcare providers. Thus, there appears to be a gap between the perception of healthcare providers and patients about initiating ACP discussions. We performed a survey using a convergent parallel mixed-methods design with three different scenarios (cerebral infarction, heart failure, and incurable lung cancer) in three questionnaires to quantitatively determine the percentages of patients and healthcare providers willing to initiate ACP discussions at four stages in the illness trajectory, ranging from healthy to undeniably ill, and to qualitatively identify perceptions underlying preferred timing. According to the patients’ survey, 72% of Japanese patients were willing to begin ACP discussions before their health deteriorated, while approximately 20% wished to postpone ACP discussions until imminent end of life. In the healthcare providers’ survey, 51% of physicians and 65% of nurses preferred initiating discussion before the patients’ illness. Thus, physicians were less willing to begin discussions before patients’ health deteriorated compared with nurses and patients.