2022 Volume 55 Issue 10 Pages 555-561
A survey of 4,123 facilities was conducted to investigate the use of the Miawase approach to dialysis, and responses were received from 1,201 facilities. Approximately 40％ of the facilities did not have a system for implementing advance care planning (ACP) or shared decision-making (SDM). The mortality rate due to dialysis discontinuation was 5％, and the non-compliance rate with “Shared decision making for the initiation and continuation of dialysis：a proposal from the Japanese Society for Dialysis Therapy” was 18％. When SDM was fully implemented, the consensus rate for all parties involved in cases with decision-making capacity and not in the terminal stages of life was 96％. The selection criteria for the statistical survey cause-of-death items “refusal of treatment (refusal of dialysis)” and “the Miawase approach to treatment” as well as death resulting from use of the Miawase approach to dialysis at the terminal stage of a complication (either “Miawase approach to treatment” only, “complication name” only, or one of these per case) differed among facilities. It is necessary to develop a system for implementing ACP and SDM in order to comply with the new proposal and to revise cause-of-death items in statistical surveys of the Miawase approach to dialysis in order to accurately determine the number of deaths associated with this method.
