Background: Recently, advance care planning (ACP) in palliative care has been attracting attention in Japan. The Japanese counterpart was established by the Ministry of Health, Labor and Welfare in November 2018. Moreover, discussions on end-of-life treatment are an important part of ACP It is suggested that individual feelings at the end-of-life are different; ACP depends on various situations. Decision making by patients themselves is recommended; however, there are cases where patients with dementia or other disorders cannot make decisions by themselves. Health providers may contact surrogates and consider their background for better ACP. We focused on patents’ families and examined factors related to the preferences of home caregivers’ and old-age health facility tenants’ families on patient ACP, including life-sustaining treatment (LST) at end-of-life.
Methods: This cross-sectional study involved home caregivers’ and old-age health facility tenants’ families in Japan. We distributed 925 self-reported questionnaires comprising items such as number of people living together, comprehension of doctor’s explanations, nursing care level and duration, the Patient Health Questionnaire (PHQ)-9 and Short Form (SF)-8, and caregivers’ LST preference.
Results: A valid response was obtained from 619 respondents [242 men and 377 women (309 in the home-care group, response rate = 61.1%; 310 in the facility-care group, response rate = 74.0%)]. The mean age of the respondents was 65.29 ± 12.09 years in the home-care group and 63.24 ± 10.39 years in the facility-care group. LST preference was significantly associated with sex, number of people living together, care duration, and comprehension of doctors’ explanations in the home-care group but was not significantly associated in the facility-care group. Furthermore, PHQ-9/SF-8 scores were not significantly associated with LST preference of the groups.
Conclusions: Factors associated with decision on ACP differed between home caregivers’ families and health facility tenants’ families. In ACP, healthcare providers should be aware of the nature of each patient’s caregiving situation and living environment when discussing LST preference.