[ Purpose] With advanced medical care and aging of the population, promoting advance care planning (ACP) in communities is becoming important. This study aimed to (1) clarify the status of ACP practice among citizens, and (2) examine the factors associated with ACP practice to promote ACP in communities.
[ Methods] This cross-sectional study used an anonymous self-administered questionnaire among citizens aged 20 years and older living in Kakegawa City. The outcomes were defined as 1) having thought about one’s end of life (Thought ACP), 2) having discussed one’s end of life with someone (Discussed ACP), and 3) having documented something about one’s end of life (Documented ACP). We performed logistic regression analysis on the responses.
[ Results] A total of 317 participants were included in the analysis (effective response rate: 23.0%). The outcomes of Thought ACP, Discussed ACP, and Documented ACP were reported by 192, 97, and 28 participants, respectively. Younger age and experience of a serious accident or illness were associated with Thought ACP. Being a female, not having financial problems, experience of a serious illness or accident, and a higher score on the view of life and death scale were associated with Discussed ACP. No variables were significantly associated with Documented ACP.
[ Conclusions] ACP practice among citizens was inadequate, and was associated with certain demographic characteristics and the experience of feeling close to death. Interventions with content that enhances the view of life and death may be useful in improving ACP practice.
[ Purpose] The purpose of this study was to identify the best nursing practices related to cooperation and collaboration with other long-term caregivers in end-of-life care at geriatric health services facilities.
[ Methods] A survey was conducted using a self-administered questionnaire that was mailed to 327 nurses working in end-of-life care at geriatric health services facilities. Fisher’s exact test was used to analyze associations between respondent characteristics and practices related to cooperation and collaboration with other caregivers.
[ Results] A total of 118 responses were received with a response rate of 36.1%. Of the total respondents, 75(63.6%) reported finding cooperation and collaboration with other caregivers. However, significantly greater percentages of the respondents with more years of experience and of those who cared for larger numbers of palliative patients than their counterparts indicated that “cooperative care provision was a result of mutual respect.” Furthermore, compared to others, a significantly greater percentage of the respondents who felt they partnered well with other caregivers indicated they “exchanged opinions with other caregivers” and “included other caregivers when speaking or dealing with a patient’s family.”
[ Conclusions] This study suggests that to ensure an efficient cooperation and collaboration with other palliative caregivers, nurses need to create opportunities to discuss patient care with them.
[ Purpose] This study aimed to identify factors associated with the discussion experience about end-of-life care.
[ Methods] Questionnaire surveys were distributed among 5,600 residents of City A in Saitama Prefecture, Japan. The questionnaires inquired regarding respondents’ attributes, handling the conflicts of opinions among family members and other interested people, health status, experience regarding thinking about death, awareness about the necessity of having discussions about end-of-life care, experience of having any such discussions, selection of proxy decision-makers, and intentions and behaviors related to the designation of written end-of-life preferences.
[ Results] The data of 1,778 respondents were analyzed. The following factors were associated with the discussion experience: awareness about the necessity of having the discussions (OR: 4.91, 95%CI: 2.14–11.30), experience regarding thinking about death (OR: 3.22, 95%CI: 2.09–4.96), selection of proxy decision-makers (behaviors) (OR: 2.60, 95%CI: 1.66–4.06), the designation of written end-of-life preferences (behaviors) (OR: 2.56, 95%CI: 1.53–4.30), the designation of the primary care physician (OR: 2.24, 95%CI: 1.33–3.75), and avoiding the subject (OR: 0.60, 95%CI: 0.40–0.90).
[ Conclusions] Increasing awareness about the necessity of having the discussions, having experiences regarding thinking about death, behaviors related to the selection of proxy decision-makers, designation of written end-of-life preferences, relationships with primary care physicians, and not avoiding the subject even in the event of disagreement were the factors that facilitated the discussions.
[ Purpose] The purpose of this study was to clarify visiting nurses’ support of intention-expression for older adults with non-cancer diseases at their end-of-life recuperation stage.
[ Methods] A qualitative descriptive design was adopted. Ten visiting nurses with over three years of experience in their field were recruited for the study. Semi-structured interviews were conducted to clarify their nursing strategies for supporting decision-making processes and communicating their care intentions for older adult patients with non-cancer diseases at their end-of-life recuperation stage.
[ Results] Visiting nurses played a key role in “creating a safe environment where patients feel free to express themselves,” whilst “building a team that supports patient individuality.” Visiting nurses could do this while being near and supporting the patients’ individual day-to-day living to accomplish their lifetime goals. Visiting nurses also provided professional support in “reinforcing patients’ core beliefs through various activities” and “validating patient philosophies of life to give them a sense of worth until they pass.”
[ Conclusions] Based on the course of the non-cancer diseases, visiting nurses built a foundation for relationships, being present at the right time to listen and understand patient values. These actions are required for patients to view the nurses as trusted individuals to whom they would want to talk. Visiting nurses formed and fostered a multidisciplinary team that was well-prepared to help the patients through to the end of life.
[ Purpose] To clarify the current state of advance care planning (ACP) in nursing homes and to examine the background that affects its practice.
[ Methods] Semi-structured interviews were conducted with seven nurses working at nursing homes, and data was analyzed by qualitative analysis.
[ Results] At nursing homes, the current state observed comprised [prioritizing the will of the family] while experiencing [confusion between ACP and advance directive
(AD) ] and [accepting the needs of the elderly]. In practicing ACP, nurses found that [it is difficult to confirm the intention of the elderly] and that [ACP complicates work]. In the background, there was a [lack of knowledge and experience about ACP] and [barriers in promoting ACP].
[ Conclusion] Nurses were confused between ACP and AD. There was a lack of knowledge about ACP and barriers in promoting ACP.
[ Purpose] To identify reasons why certified nurse specialists (CNS) in gerontological nursing succeeded in implementing Advance Care Planning (ACP) for elderly people with non-cancer disease and their families despite hesitation on their part.
[ Methods] Interview surveys were conducted with CNS in gerontological nursing; these surveys were analyzed qualitatively and inductively.
[ Results] The participants’ desire for patients to spend their final days as they wish and the formers’ prediction that patients will be unable to do so in their current circumstances—a desire and a prediction shaped by experience—participants judged that ACP must be performed based on the patient’s physical condition, speech, behavior, social background, status, and disease outlook. In addition, CNS in gerontological nursing implemented ACP despite hesitation from patients and their families due to a sense of vocation and confidence in their ability to discuss issues.