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Sakamoto A, Inokuchi R, Iwagami M, Hanari K, Tamiya N. Association between physicians' characteristics and their knowledge, attitudes, and practices regarding advance care planning: a cross-sectional study. BMC Palliat Care 2023; 22:134. [PMID: 37697265 PMCID: PMC10494406 DOI: 10.1186/s12904-023-01253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Despite physicians' vital role in advance care planning, a limited number of physicians practice it. This study assessed factors associated with physicians' knowledge, attitudes, and practices regarding advance care planning. METHODS This cross-sectional study used data from an anonymous survey conducted by the Japanese Ministry of Health, Labour and Welfare. Questionnaires were mailed to 4500 physicians in November and December 2022. Data from 1260 respondents were analyzed. RESULTS Of the respondents, 46.4%, 77.0%, and 82.0% reported good knowledge of advance care planning, agreed with promoting it, and with its provision by medical/care staff, respectively. Male physicians were significantly less likely to support advance care planning (odds ratio: 0.54, 95% confidence interval: 0.35-0.84) or agree to its provision by medical/care staff (odds ratio: 0.47, 95% confidence interval: 0.29-0.78) but significantly more likely to practice it (odds ratio: 1.58, 95% confidence interval: 1.05-2.36). Physicians specialized in surgery or internal/general/palliative medicine were more knowledgeable about advance care planning and more likely to practice it. Physicians working in clinics were significantly less knowledgeable (odds ratio: 0.33, 95% confidence interval: 0.25-0.44) about advance care planning and less likely to support it (odds ratio: 0.37, 95% confidence interval: 0.27-0.50), agree with its provision by medical/care staff (odds ratio: 0.54, 95% confidence interval: 0.39-0.75), or to practice it (odds ratio: 0.16, 95% confidence interval: 0.12-0.22). CONCLUSIONS Physicians working in clinics had less knowledge of advance care planning, less supportive attitudes, and less likely to practice it. Knowledge, attitudes and practice also varied by gender and specialty. Interventions should target physicians working in clinics.
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Affiliation(s)
- Ayaka Sakamoto
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Ryota Inokuchi
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan.
| | - Masao Iwagami
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Kyoko Hanari
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
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Fan R, Yang S, Bu X, Chen Y, Wang Y, Shen B, Qiu C, Li X. Symptomatic Features and Factors Associated With Do-Not-Resuscitate Consent in Advanced Cancer Patients Admitted to Palliative Care Ward. Am J Hosp Palliat Care 2022; 39:1312-1324. [PMID: 35041534 DOI: 10.1177/10499091211068824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to conduct a retrospective cross-sectional study to investigate the prevalence of symptoms and symptom clusters on sociodemographic and disease characteristics, as well as factors associated with Do-Not-Resuscitate (DNR) consent. Advanced cancer patients were enrolled between 2018 and 2020 with available data. Demographic and clinical data were obtained for analysis from Hospital Information System (HIS) in China. Symptom clusters were extracted by hierarchical cluster analysis. Chi-square test and multiple logistic regression were conducted to investigate the prevalence characteristics of symptoms and influencing factors of DNR consent, respectively. 798 advanced cancer patients were enrolled. The most prevalent symptoms were pain (93%), anorexia (36.5%), and sleep disorders (34.2%). High heart rate was associated with poor performance status and more symptoms. Three clusters were extracted: fatigue-related, respiratory-circulatory system, and digestive system symptom clusters. The incidence of symptoms was statistically significant in age, gender, education level, residence, BMI, performance status, distress score, ADL, and primary pain level. The DNR signature rate was 15.5%. Female, distant metastasis, in-ward rescue, and appearance of dyspnea were independent influencing factors of DNR signature.Chinese hospitalized cancer patients had more symptoms burden that were influenced by various demographic characteristics, especially pain and fatigue-related symptoms. Concerning the trajectory of vital signs is important among advanced cancer patients. The DNR signature rate was lower and our finding indicating an urgency to accurately assess the prognosis and give more palliative care education to enhance DNR rates and early signing in Chinese context.
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Affiliation(s)
- Rongrong Fan
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Siyu Yang
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Xiaofan Bu
- 12570Xiangya Nursing School of Central South University, Changsha, China
| | - Yongyi Chen
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Ying Wang
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Boyong Shen
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Cuiling Qiu
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Xuying Li
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
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Okamoto S, Uneno Y, Kawashima N, Oyamada S, Hiratsuka Y, Tagami K, Muto M, Morita T. Difficulties Facing Junior Physicians and Solutions Toward Delivering End-of-Life Care for Patients with Cancer: A Nationwide Survey in Japan. Palliat Med Rep 2022; 3:255-263. [PMID: 36341469 PMCID: PMC9629909 DOI: 10.1089/pmr.2022.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Junior physicians' perceived difficulty in end-of-life care of patients with cancer has not been structurally investigated; therefore, current challenges and solutions in this area remain unknown. OBJECTIVES To identify some difficulties junior physicians face in delivering end-of-life care for patients with cancer and to clarify the support required to reduce these difficulties. DESIGN A nationwide survey was conducted in over 300 institutions selected randomly from 1037 clinical training hospitals in Japan. PARTICIPANTS From each of these institutions, two resident physicians of postgraduate year (PGY) 1 or 2, two clinical fellows of PGY 3-5, and an attending physician were requested to respond to the survey. MEASUREMENTS The survey investigated issues regarding end-of-life care using the palliative care difficulties scale with two additional domains ("discussion about end-of-life care" and "death pronouncement"). Items related to potential solutions for alleviating the difficulties as well were investigated. RESULTS A total of 198 resident physicians, 134 clinical fellows, and 96 attending physicians responded to the survey (response rate: 33.0%, 22.3%, and 32.0%). The results revealed that junior physicians face difficulties within specific domains of end-of-life care. The most challenging domain comprised communication and end-of-life discussion with patients and family members, symptom alleviation, and death pronouncement. The most favored supportive measure for alleviating these difficulties was mentorship, rather than educational opportunities or resources regarding end-of-life care. CONCLUSION The findings of this study reveal the need for further effort to enrich the mentorship and support systems for junior physicians delivering end-of-life care.
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Affiliation(s)
- Soichiro Okamoto
- Medical Corporation Teieikai Chiba Home Care Clinic, Chiba, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- *Address correspondence to: Yu Uneno, MD, Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
| | - Natsuki Kawashima
- Department of Palliative Care, Tsukuba Medical Center, Tsukuba, Japan
| | | | - Yusuke Hiratsuka
- Department of Palliative Care, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Keita Tagami
- Department of Palliative Care, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Morita
- Division of Supportive and Palliative Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Hamano J, Hanari K, Tamiya N. End-of-life care preferences of the general public and recommendations of healthcare providers: a nationwide survey in Japan. BMC Palliat Care 2020; 19:38. [PMID: 32209096 PMCID: PMC7093951 DOI: 10.1186/s12904-020-00546-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A better understanding of differences between the preferences of the general public and the recommendations of healthcare providers with regard to end-of-life (EOL) care may facilitate EOL discussion. METHODS The aim of this study was to clarify differences between preferences of the general public and recommendations of healthcare providers with regard to treatment, EOL care, and life-sustaining treatment (LST) based on a hypothetical scenario involving a patient with advanced cancer. This study comprised exploratory post-hoc analyses of "The Survey of Public Attitude Towards Medical Care at the End of life", which was a population based, cross-sectional anonymous survey in Japan to investigate public attitudes toward medical care at the end of life. Persons living in Japan over 20 years old were randomly selected nationwide. Physicians, nurses, and care staff were recruited at randomly selected facilities throughout Japan. The general public data from the original study was combined to the data of healthcare providers in order to conduct exploratory post-hoc analyses. The preferences of the general public and recommendations of healthcare providers with regard to EOL care and LST was assessed based on the hypothetical scenario of an advanced cancer patient. RESULTS All returned questionnaires were analyzed: 973 from the general public, 1039 from physicians, 1854 from nurses, and 752 from care staff (response rates of 16.2, 23.1, 30.9, and 37.6%, respectively). The proportion of the general public who wanted "chemotherapy or radiation", "ventilation", and "cardiopulmonary resuscitation" was significantly higher than the frequency of these options being recommended by physicians, nurses, and care staff, but the general public preference for "cardiopulmonary resuscitation" was significantly lower than the frequency of its recommendation by care staff. CONCLUSION Regarding a hypothetical scenario for advanced cancer, the general public preferred more aggressive treatment and more frequent LST than that recommended by healthcare providers.
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Affiliation(s)
- Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Ibaraki, Japan.
| | - Kyoko Hanari
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Nanako Tamiya
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Ibaraki, Japan
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Binstock JM, Pino MA, Primavera LH. What Physicians Wished They Would Have Learned in Medical School: a Survey. MEDICAL SCIENCE EDUCATOR 2020; 30:299-306. [PMID: 34457671 PMCID: PMC8368472 DOI: 10.1007/s40670-019-00903-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE Medical students must be provided the basic science knowledge appropriate and applicable for preparing them for best-practice medicine. To date, there have been no documented studies in the USA that have directly surveyed practicing physicians on their perspectives of their basic science/preclinical medical school education and how it could be modified to help them deliver best patient care. This study was the first to examine this information. METHOD A survey was administered to the alumni of Touro College of Osteopathic Medicine, Harlem, NY (2011-2018), with questions on examining perspectives on basic science disciplines, the need for a basic science refresher course, and other educational topics. In addition, questions relating to demographics and type of medical practice were also asked. Statistical analysis was performed using SPSS. RESULTS (1) Gender (N = 122): 55% male and 44% female; (2) medical specialty (N = 107): 51.40% Primary Care physicians (Family medicine, Internal medicine, Pediatrics), 48.60% Other Specialties; (3) top Disciplines that "should have more": Physiology (41.1%), Pharmacology (39.3%), and Preventative Medicine/Public Health (39.3%); Top disciplines that "should have less": Histology Laboratory (38.32%), Embryology (35.51%), Histology (didactic) (28.30%) (N = 107); (4) top topics "most important" to be included in curriculum: Analysis of Journal Articles (70.10%), Clinical Cases (70.1%), and Early Patient Exposure (64.5%) (N = 107); (5) presentation of a clinically relevant Basic Science refresher course had a positive response (84.4%) (N = 107). CONCLUSIONS Pharmacology, Physiology, Clinical Cases, Journal Article Analysis, and Early Patient exposure were among topics requiring "more" in preclinical education. A clinically relevant basic science course was deemed useful. The perspectives of practicing physicians should be included when designing future medical school curriculums.
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Affiliation(s)
- Judith M. Binstock
- Touro College of Osteopathic Medicine, 230 West 125th Street, New York, NY 10027 USA
| | - Maria A. Pino
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd., Old Westbury, NY 11568 USA
| | - Louis H. Primavera
- Touro College School of Health Sciences, 1700 Union Blvd., Bay Shore, NY 11706 USA
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