Barriers of good death concordant with patient preference in community ：a qualitative study on emergency transport of

Abstract

The purpose of this study is to understand the structure of the issues related to use of ambulance services by the elderly，and to obtain insights for strategies for solving the issues. Semi-structured individual or focus-group interviews were conducted on 216 healthcare professionals from 31 institutions in Kobe，including 68 physicians，59 nurses，6 policy makers. Thematic analyses were performed. The　major themes identified included： 1） unclear preferences of patients about future medical care，2） barriers to ACP implementation，3） unavailability of sharing health information about ACP preference and physical conditions of patients，4） lack of cooperation among emergency department，community medical services，and long-term care facilities，and 5） insufficient local resources and public involvement． The proposals for solving these issues included; 1） clarification of the definitions，components，and evaluation methods of ACP suitable for the Japanese ，2） establishment of electronic sharing system about medical information including ACP of patients ，3） reduction of unwanted or unnecessary emergency transportation and hospitalization through cooperation of emergency department，primary care services，and long-term care facilities，and 4） fostering culture and system to think together with the residents and work toward a better society.