ABSTRACT
Objective: To review the current advance care planning (ACP) in research and clinical settings globally, and identify immediate needs in Japan. Methods: We searched reviews in MEDLINE and original articles in ICHUSHI published up to July 2019, using the Medical Subject Heading (MeSH) thesaurus term ACP; we specifically searched for papers in English or Japanese. Results: We selected 849 reviews from MEDLINE. The majority were published in the United States, and approximately 50 in the United Kingdom. We selected 2,264 articles from ICHUSHI, although 186 were original and there were few reviews. Clearly, there are far fewer ACP publications in Japan than in the US. In Japan, a common concept of ACP is not defined among researchers, medical providers, and the government for Japanese culture and social background. Furthermore, there are limited interventional ACP studies among community-dwelling people, regardless of their use of medical or long-term care services, and despite the Japanese government’s efforts to encourage ACP use. Conclusion: The concept of ACP in the Japanese culture should be identified immediately, and it is essential to provide evidence of the effectiveness of ACP among community-dwelling people. In particular, further ACP studies are needed among people provided with different kinds of home care to help support their satisfaction of end-of-life care, which is a part of community integrated care.
ABSTRACT
Purpose: We aimed to clarify the factors associated with the support for their understanding of prognosis by visiting nurses of patients with end-stage cancer likely involves a patient’s wish to die in a desired place. Methods: A cross-sectional nationwide anonymous questionnaire survey was conducted among visiting nurses at 1000 randomly selected home care agencies. Results: Three hundred seventy-four surveys were analyzed. An explanation of the prognosis with regard to daily life was provided to 27.8% of patients. Factors associated with the support given by nurses included notifying patients of a limited prognosis (odds ratio [OR], 3.22; 95% confidence interval [95%CI], 1.81-5.73), recognition of the support by the nurse (OR, 2.12; 95%CI, 1.02-4.43), nurses’ recognition of the patients’ need for a support (OR, 1.54; 95%CI, 1.08-2.21), and having experience in providing home care for at least five patients with end-stage cancer per year (OR, 1.78; 95%CI, 1.04-3.05). Conclusions: The findings suggested that promoting the aforementioned four items is necessary to allow patients their wish to die in a desired place and for visiting nurses to support for their understanding of prognosis.
ABSTRACT
<b>Objective</b>: The objective of this research is to categorize longitudinally the effects of events prompting or hampering the continuation of home care of terminal cancer patients to the places of their deaths in order to identify patterns for such events. <b>Methodology</b>: Semi-structured interviews were held with 17 visiting nurses. Focusing on the two cases where the patient died at home and in the hospital, the reasons for requesting hospitalization and any change in the situation during home care, the response of the visiting nurse to the situation at that time and others were determined. <b>Results</b>: The patients who died at home were categorized into 1) the patient had wanted home care or death at home, 2) the patient experienced events that prompted and hampered the continuation of home care but continued home care until the end, and 3) the patient died at home owing to the earnest desire of the assistant caregiver. The patients who died in hospital were categorized into 1) the patient decided on hospitalization because the symptoms became severe, 2) the patient had wished for home care but faced multiple events that hampered the continuation of home care, and 3) the family of the patient had been less willing to provide care and hospitalized the patient due to according to the opinion of the doctor. <b>Conclusion</b>: By longitudinally categorizing the events that prompted or hampered the continuation of home care, this research may give useful suggestions for appropriate measures based on those patterns.