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Wammes JD, Nakanishi M, van der Steen JT, MacNeil Vroomen JL. The Revised Medical Care Act is associated with a decrease in hospital death for the total Japanese older adult population regardless of dementia status: An interrupted time series analysis. PLoS One 2022; 17:e0264624. [PMID: 35239744 PMCID: PMC8893620 DOI: 10.1371/journal.pone.0264624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background In 2006, Japan introduced the Revised Medical Care Act aimed to shift end-of-life care from hospitals to communities. For patients and families, dying in hospital can be highly distressing. Persons with dementia are especially susceptible to negative hospital-related outcomes. This study aims to evaluate whether the Revised Medical Care Act is associated with a decrease in the proportion of hospital deaths for older adults and persons with dementia over a 20-year period covering the reform. Methods and findings This is a population-level, repeated cross-sectional study using mortality data from Vital Statistics Japan. Participants were Japanese older adults 65 years or older with and without dementia who died between 1996 and 2016. The policy intervention was the 2006 Revised Medical Care Act that increased community care infrastructure. The primary outcome was location of death in hospital, nursing home, home, or elsewhere. The trend in the proportion of location of death, before and after the reforms was estimated using an interrupted time-series analysis. All analyses were adjusted for sex and seasonality. Of the 19,307,104 older adult decedents, 216,442 had dementia identified on their death certificate. Death in nursing home (1.10, 95% CI 1.10–1.10), home (1.08, 95% CI 1.08–1.08), and elsewhere (1.07, 95% CI 1.07–1.07) increased over time compared to hospital deaths for the total population after reform implementation. Nursing home (1.04, 95% CI 1.03–1.05) and home death (1.11, 95% CI 1.10–1.12) increased after reform implementation for persons with dementia. Conclusion This study provides evidence that the 2006 Revised Medical Care Act was associated with decreased older adults dying in hospital regardless of dementia status; however, hospital continues as the primary location of death.
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Affiliation(s)
- Joost D. Wammes
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janet L. MacNeil Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Hirakawa Y, Aita K, Nishikawa M, Arai H, Miura H. Facilitating Advance Care Planning for Patients With Severe COPD: A Qualitative Study of Experiences and Perceptions of Community Physicians, Nurses, and Allied Health Professionals. Home Healthc Now 2021; 39:81-90. [PMID: 33662966 PMCID: PMC7934328 DOI: 10.1097/nhh.0000000000000945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity worldwide. Patients with severe COPD often fail to receive adequate palliative care and are subject to undesired hospital transfers and cardiopulmonary resuscitation. Although promoting advance care planning (ACP) in the community can help ensure the optimal delivery of palliative care for patients with COPD, the key challenges to routinely implementing ACP are not known. The aim of this study was to identify the perception of healthcare professionals with regard to ACP for adults living with severe COPD and the challenges to facilitating ACP. A multicenter qualitative study design was used. In-depth semistructured interviews were held involving 38 healthcare professionals from 19 institutions in Japan. Text data were analyzed by content analysis. Five main themes capturing the challenges to routine implementation of ACP were identified: daily decision-making; sense of ethical decision-making; in-depth interviewing skills; collaborative information sharing among team members; and knowledge dissemination regarding ACP. The model demonstrates the complexity inherent in ACP facilitation for community-dwelling adults with severe COPD, with all the elements required for successful ACP implementation. We recommend an approach that recognizes the importance of stakeholder education, particularly educating professionals to develop the knowledge, attitudes, and skills required for ACP facilitation: in-depth interviewing, collaborative information sharing, and ethical analysis, focusing on decision-making concerning everyday life support.
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Cohen-Mansfield J, Brill S. After providing end of life care to relatives, what care options do family caregivers prefer for themselves? PLoS One 2020; 15:e0239423. [PMID: 32977327 PMCID: PMC7518928 DOI: 10.1371/journal.pone.0239423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 09/05/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives We examined how caregivers who had cared for a relative at end of life (EoL) wished to be cared for in the event that they experienced advanced dementia or physical disability in the future, and what factors influenced their preferences for EoL care. Methods In this mixed-methods study, 83 participants, recruited from multiple sources in Israel, were interviewed concerning socio-demographic factors, health status, past experience with EoL, preference for extension of life vs. quality of life (QoL), willingness to be dependent on others, and preferences for EoL care. Results In case of advanced dementia, 58% preferred euthanasia or suicide; around a third chose those for physical disability. Care by family members was the least desired form of care in the advanced dementia scenario, although more desirable than institutional care in the physical disability scenario. QoL was rated as the highest factor impacting preferences for EoL care. Men demonstrated a higher preference than women for extension of life over QoL. Conclusion Our study points to the need for society to consider solutions to the request of participants to reject the type of EoL experienced by their relatives. Those solutions include investing in improving the quality of life at the end of life, and offering alternatives such as euthanasia, which a large proportion of our participants found ethically and medically appropriate within the current system of care in the event of severe physical disability, and more so in the event of advanced dementia.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Shai Brill
- Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- Beit Rivka Medical Center, Petah Tikva, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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Shaku F, Tsutsumi M, Nakamura A, Takagi H, Otsuka T, Maruoka S. Factors Relating to Caregivers' Preference for Advance Care Planning of Patients in Japan: A Cross-Sectional Study. Am J Hosp Palliat Care 2020; 36:727-733. [PMID: 31256612 DOI: 10.1177/1049909119844517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to examine the preferences of home caregivers on patient advance care planning (ACP), including life-sustaining treatment (LST) and the factors relating to these preferences. BACKGROUND Personalized ACP aims to respect the autonomy and choices of terminally ill patients regarding end-of-life care. However, there have been cases wherein doctors must instead discuss ACP with surrogates (including caregivers) for various reasons such as dementia, intractable neurologic diseases, and cerebrovascular accident. METHODS In this cross-sectional study, self-written questionnaires (filled by individuals themselves) were distributed to 506 in-home caregivers in 6 Japanese prefectures; the questionnaires contained items on caregiver and patient demographics, number of people living together in a caregiver's home (aside from patients), care duration, comprehension level of doctors' explanations regarding their patient's condition, patient diseases, whether caregivers have or have not told patients about their disease, level of nursing care, and caregiver LST preference (preferred or not preferred). The questionnaire package also contained the Burden Index of Caregiver-11, Patient Health Questionnaire-9, and Short Form-8 Health Survey. RESULTS Valid responses were obtained from 309 caregivers. More than half of them were not sure of their patient's LST preference. Sex, number of people living together in a care home, comprehension level of doctors' explanations, and care duration were found to be the significant factors relating to caregivers' LST preference (P < .05). CONCLUSION Health providers should be cognizant of the background factors relating to caregiver ACP preference when deciding on LST for terminal patients.
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Affiliation(s)
- Fumio Shaku
- 1 Department of Psychosomatic Internal Medicine, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan.,2 Department of Internal Medicine, Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | | | | | | | - Shuichiro Maruoka
- 1 Department of Psychosomatic Internal Medicine, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan.,2 Department of Internal Medicine, Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
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Content of advance care planning among Japanese elderly people living at home: A qualitative study. Arch Gerontol Geriatr 2017; 70:162-168. [DOI: 10.1016/j.archger.2017.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 11/22/2022]
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Kinjo K, Sairenji T, Koga H, Osugi Y, Yoshida S, Ichinose H, Nagai Y, Imura H, South-Paul JE, Meyer M, Honda Y. Cost of physician-led home visit care (Zaitaku care) compared with hospital care at the end of life in Japan. BMC Health Serv Res 2017; 17:40. [PMID: 28095906 PMCID: PMC5240473 DOI: 10.1186/s12913-016-1961-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 12/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physician-led home visit care with medical teams (Zaitaku care) has been developed on a national scale to support those who wish to stay at home at the end of life, and promote a system of community-based integrated care in Japan. Medical care at the end of life can be expensive, and is an urgent socioeconomic issue for aging societies. However medical costs of physician-led home visits care have not been well studied. We compared the medical costs of Zaitaku care and hospital care at the end of life in a rapidly aging community in a rural area in Japan. METHODS A cross-sectional study was performed to compare the total medical costs during patients' final days of life (30 days or less) between Zaitaku care and hospital care from September 2012 to August 2013 in Fukuoka Prefecture, Japan. RESULTS Thirty four patients died at home under Zaitaku care, and 72 patients died in the hospital during this period. The average daily cost of care during the last 30 days did not differ significantly between the two groups. Although Zaitaku care costs were higher than hospital care costs in the short-term (≦10 days, Zaitaku care $371.2 vs. Hospital care $202.0, p = 0.492), medical costs for Zaitaku care in the long-term care (≧30 days) were less than that of hospital care ($155.8 vs. $187.4, p = 0.055). CONCLUSIONS Medical costs of Zaitaku care were less compared with hospital care if incorporated early for long term care, but it was high if incorporated late for short term care. For long term care, medical costs for Zaitaku care was 16.7% less than for hospitalization at the end of life. This physician-led home visit care model should be an available option for patients who wish to die at home, and may be beneficial financially over time.
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Affiliation(s)
- Kentaro Kinjo
- Department of General Medicine, Morinosato Hospital/Kameda Hospital, Tokai University, Keio University, 3-1-1 Morinosato, Atsugi, Kanagawa, 243-0122, Japan.
| | - Tomoko Sairenji
- Department of Family Medicine, University of Washington, E304 Health Sciences 1959 NE Pacific Street, Seattle, WA, 98195-6390, USA
| | - Hidenobu Koga
- Department of Medical Information Analysis, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Yasuhiro Osugi
- Department of General Medicine, Fujita Health University, 1-98 Kutzukake Dengakugakubo, Toyoake, 470-1192, Japan
| | - Shin Yoshida
- Department of General Medicine, Aso Iizuka Hospital, Iizuka Kaita Family Medicine Residency Program, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Hidefumi Ichinose
- Department of General Medicine, Aso Iizuka Hospital, Iizuka Kaita Family Medicine Residency Program, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Yasunori Nagai
- You-no-mori clinic, 444-1 Bepucho, Matsuyama, Ehime, 791-8056, Japan
| | - Hiroshi Imura
- Department of General Medicine, Aso Iizuka Hospital, Iizuka Kaita Family Medicine Residency Program, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Jeannette E South-Paul
- Department of Family Medicine, University of Pittsburgh, 4420 Bayard Street, Suite 520, Pittsburgh, PA, 15260, USA
| | - Mark Meyer
- Department of Family Medicine, University of Pittsburgh, 4420 Bayard Street, Suite 520, Pittsburgh, PA, 15260, USA
| | - Yoshihisa Honda
- Kaita Hospital, 1061 Haranokuchi, Iizuka, Fukuoka, 820-1114, Japan
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Fukui S, Morita T, Yoshiuchi K. Development of a Clinical Tool to Predict Home Death of a Discharged Cancer Patient in Japan: a Case-Control Study. Int J Behav Med 2016; 24:584-592. [DOI: 10.1007/s12529-016-9619-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Igarashi A, Miyashita M, Morita T, Akizuki N, Akiyama M, Shirahige Y, Sato K, Yamamoto-Mitani N, Eguchi K. Association Between Bereaved Families' Sense of Security and Their Experience of Death in Cancer Patients: Cross-Sectional Population-Based Study. J Pain Symptom Manage 2016; 51:926-32. [PMID: 26706626 DOI: 10.1016/j.jpainsymman.2015.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 11/24/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
CONTEXT The sense of security scale was developed to indicate care quality within the community. Bereaved families have perspective to evaluate the quality of the care system. OBJECTIVES The aim was to examine associations between end-of-life care and sense of security regarding regional cancer care among bereaved families. METHODS A cross-sectional population-based survey was conducted with families of cancer patients who died in regional areas of Japan. RESULTS A total of 1046 family caregivers of patients responded to surveys (effective response rate of 65%). In multiple regression analyses, the families' higher age (P < 0.001), home death (P = 0.039), better health status of the family at patients' end of life (P = 0.016), lower caregiving burden (P < 0.001), and elements of perceived good patient death, including being free from physical distress (P < 0.001), trusting the physician (P < 0.001), living in calm circumstances (P = 0.042), and feeling that one's life was fulfilling (P = 0.035), were associated with a higher sense of security. CONCLUSION Quality of death and lower burden on family caregivers were associated with families' sense of security. This suggests strategies for improving care quality for each patient to improve the sense of security.
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Affiliation(s)
- Ayumi Igarashi
- Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Graduate School of Tohoku University, Sendai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Nobuya Akizuki
- Psycho-Oncology Division, Chiba Cancer Center, Chiba, Japan
| | - Miki Akiyama
- Faculty of Environment and Information Studies, Keio University, Tokyo, Japan
| | | | - Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Graduate School of Tohoku University, Sendai, Japan
| | - Noriko Yamamoto-Mitani
- Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Eguchi
- Department of Internal Medicine and Medical Oncology, Teikyo University School of Medicine, Tokyo, Japan
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