1
|
Yoshida S, Hirai K, Ohtake F, Masukawa K, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Preferences of bereaved family members on communication with physicians when discontinuing anticancer treatment: referring to the concept of nudges. Jpn J Clin Oncol 2024; 54:787-796. [PMID: 38553776 PMCID: PMC11228860 DOI: 10.1093/jjco/hyae038] [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: 12/11/2023] [Accepted: 03/11/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND This study aimed to clarify the situation and evaluate the communication on anticancer treatment discontinuation from the viewpoint of a bereaved family, in reference to the concept of nudges. METHODS A multi-center questionnaire survey was conducted involving 350 bereaved families of patients with cancer admitted to palliative care units in Japan. RESULTS The following explanations were rated as essential or very useful: (i) treatment would be a physical burden to the patient (42.9%), (ii) providing anticancer treatment was impossible (40.5%), (iii) specific disadvantages of receiving treatment (40.5%), (iv) not receiving treatment would be better for the patient (39.9%) and (v) specific advantages of not receiving treatment (39.6%). The factors associated with a high need for improvement of the physician's explanation included lack of explanation on specific advantages of not receiving treatment (β = 0.228, P = 0.001), and lack of explanation of 'If the patient's condition improves, you may consider receiving the treatment again at that time.' (β = 0.189, P = 0.008). CONCLUSIONS Explaining the disadvantages of receiving treatment and the advantages of not receiving treatment, and presenting treatment discontinuation as the default option were effective in helping patients' families in making the decision to discontinue treatment. In particular, explanation regarding specific advantages of not receiving treatment was considered useful, as they caused a lower need for improvement of the physicians' explanation.
Collapse
Affiliation(s)
- Saran Yoshida
- Graduate School of Education, Tohoku University, Sendai, Miyagi, Japan
| | - Kei Hirai
- Graduate School of Human Science, Osaka University, Suita, Osaka, Japan
| | - Fumio Ohtake
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Osaka, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| |
Collapse
|
2
|
Osuna E, Luna A, Pérez-Cárceles MD. [The right to patient autonomy. Updating in daily clinical care]. Med Clin (Barc) 2024; 162:e52-e55. [PMID: 38471981 DOI: 10.1016/j.medcli.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Eduardo Osuna
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España
| | - Aurelio Luna
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España
| | - María D Pérez-Cárceles
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España.
| |
Collapse
|
3
|
Nelis S, Dijkstra HP, Damman OC, Farooq A, Verhagen E. Shared decision-making with athletes: a survey study of healthcare professionals' perspectives. BMJ Open Sport Exerc Med 2024; 10:e001913. [PMID: 38736642 PMCID: PMC11086382 DOI: 10.1136/bmjsem-2024-001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives Shared decision-making (SDM) is a trending topic in athlete health care; however, little is known about its use in a sports context. This study aimed to measure knowledge and self-perceived practice of SDM among healthcare professionals working with athletes. This study evaluates SDM attitudes and preferences and explores how healthcare professionals perceive the factors influencing SDM. Methods A web-based cross-sectional survey with open-ended and closed-ended questions. Results Our survey was completed by 131 healthcare professionals. The majority (63.6%) reported to prefer SDM and to be confident in their SDM skills (81.1%). Despite this inclination and confidence, only one in four clinicians reported consistent practice of SDM when feasible. Additionally, most clinicians lacked SDM knowledge. The barriers perceived by healthcare professionals included time constraints (17.6%), limited patient knowledge (17.6%), limited patient motivation (13.5%) and language barriers (16.2%). Importantly, two-thirds of the participants believed that SDM in athlete health care differs from SDM in non-athletes due to the high-pressure environment, the tension between performance and health, and the involvement of multiple stakeholders with potentially conflicting interests. Conclusions Although healthcare professionals preferred SDM, they did not fully understand nor routinely practice it. Most healthcare professionals perceive SDM in athlete health care to differ from SDM in the general population. Therefore, to inform the implementation of SDM in athlete health care, future research is crucial to understand better what makes practising SDM unique in this setting.
Collapse
Affiliation(s)
- Sofie Nelis
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Hendrik Paul Dijkstra
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Olga Catherina Damman
- Department of Public and Occupational Health, Amsterdam UMC, Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Abdulaziz Farooq
- FIFA Medical Center for Excellence, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Takimoto Y, Nabeshima T. The Gap in Attitudes Toward Withholding and Withdrawing Life-Sustaining Treatment Between Japanese Physicians and Citizens. AJOB Empir Bioeth 2024:1-11. [PMID: 38588396 DOI: 10.1080/23294515.2024.2336907] [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: 04/10/2024]
Abstract
BACKGROUND According to some medical ethicists and professional guidelines, there is no ethical difference between withholding and withdrawing life-sustaining treatment. However, medical professionals do not always agree with this notion. Patients and their families may also not regard these decisions as equivalent. Perspectives on life-sustaining treatment potentially differ between cultures and countries. This study compares Japanese physicians' and citizens' attitudes toward hypothetical cases of withholding and withdrawing life-sustaining treatment. METHODS Ten vignette cases were developed. A web-based questionnaire was administered to 457 citizens and 284 physicians to determine whether they supported withholding or withdrawing treatment. RESULTS In a case where a patient had an advance directive refusing ventilation, 77% of the physicians and 68% of the citizens chose to withhold treatment. In a case where there was an advance directive but the patient's family requested treatment, 55% of the physicians and 45% of the citizens chose to withhold the ventilator. When a family requested withdrawal of the ventilator but patient wishes were unknown, 19% of the physicians and 48% of the citizens chose to withdraw the ventilator. However, when the patient had also indicated their wishes in writing, 49% of the physicians and 66% of the citizens chose to withdraw treatment. More physicians were prepared to withdraw dialysis (84%) and artificial nutrition (81%) at a patient's request than mechanical ventilation (49%). CONCLUSIONS A significant proportion of Japanese physicians and citizens were reluctant to withhold or withdraw life-sustaining treatment, even in cases where the patient had indicated their wishes in writing. They were more likely to withhold than withdraw treatment, and more likely to withdraw artificial nutrition than mechanical ventilation. Japanese physicians gave significant weight to family views about treatment but were less likely to agree to withdraw treatment than citizens, indicating a potential source of conflict in clinical settings.
Collapse
Affiliation(s)
- Yoshiyuki Takimoto
- Department of Biomedical Ethics, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tadanori Nabeshima
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| |
Collapse
|
5
|
Xu H, Yuan M. Family roles in informed consent from the perspective of young Chinese doctors: a questionnaire study. BMC Med Ethics 2024; 25:2. [PMID: 38172849 PMCID: PMC10765650 DOI: 10.1186/s12910-023-00999-6] [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: 09/07/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Based on the principle of informed consent, doctors are required to fully inform patients and respect their medical decisions. In China, however, family members usually play a special role in the patient's informed consent, which creates a unique "doctor-family-patient" model of the physician-patient relationship. Our study targets young doctors to investigate the ethical dilemmas they may encounter in such a model, as well as their attitudes to the family roles in informed consent. METHODS A questionnaire was developed including general demographic characteristics, the fulfillment of the obligation to fully inform, who will be informed, and the ethical dilemmas in decision-making. We recruited a total of 421 doctors to complete this questionnaire, of which 368 met the age requirements for this study. Cross tabulation and Pearson's chi-squared test were used to analyze the differences between types of patients for categorical variables, and a p-value < 0.05 was considered statistically significant. RESULTS Our data shows that only 20 doctors (5.40%) stated "informing the patient alone is sufficient" when it comes to informing patients of their serious conditions. The rest of the participants would ensure that the family was informed. When facing elderly patients with decision-making capacity, the data was statistically different (3.8%; P < 0.001) The primary reason for ensuring that family members be informed differs among the participants. In addition, when family members asked doctors to conceal the patient's medical condition for the best interests of patients, 270 doctors (73.4%) would agree and cooperate with the family. A similar proportion (79.6%) would do so when it comes to elderly patients. CONCLUSIONS (1) Chinese doctors pay extra attention to informing the patient's family, which may not be in the patient's best interests. (2) Chinese doctors treat adult (but not elderly) patients and elderly patients differently when it comes to informing family members. (3) When family members request that doctors withhold information from patients "in the best interest of the patient," the majority choose to comply with the request, although this may cause them distress.
Collapse
Affiliation(s)
- Hanhui Xu
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Mengci Yuan
- School of Medicine, Nankai University, Tianjin, 300071, China.
| |
Collapse
|
6
|
Sekine O, Kitakata H, Kohsaka S, Fujisawa D, Nakano N, Shiraishi Y, Kishino Y, Katsumata Y, Yuasa S, Fukuda K, Kohno T. Perspectives of hospitalized heart failure patients: preferred and perceived participation roles in treatment decisions. Heart Vessels 2023; 38:1244-1255. [PMID: 37264250 DOI: 10.1007/s00380-023-02275-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
Shared decision-making (SDM) is a pivotal process in seeking optimal individual treatment and incorporating clinical evidence and patients' autonomous preferences. However, patients' actual attitudes toward participation in decision-making for state-of-the-art heart failure (HF) treatment remain unclear. We conducted a questionnaire-based survey distributed by nurses and physicians specializing in HF care to assess patients' preferred and perceived participation roles in treatment decision-making during the index hospitalization, rated on five scales (from extremely passive to purely autonomous attitudes). Simultaneously, we investigated the important factors underlying treatment decision-making from the perspective of hospitalized HF patients. Of the 202 patients who were approached by our multidisciplinary HF team between 2017 and 2020, 166 (82.2%) completed the survey. Logistic regression analyses were conducted to identify the clinical determinants of patients who reported that they left all decisions to physicians (i.e., extremely passive attitude). Of the 166 participants (male 67.5%, median age 73 years), 32.5% preferred an extremely passive attitude, while 61.4% reported that they actually chose an extremely passive attitude. A sole determinant of choosing an extremely passive decision-making role was lower educational status (odds ratio: 2.11, 95% confidence interval 1.11-4.00). The most important factor underlying the decision-making was "Physician recommendation" (89.2%). Notably, less than 50% considered "In alignment with my values and preferences" as an important factor underlying treatment decision-making. The majority of HF patients reported that they chose an extremely passive approach, and patients prioritized physician recommendation over their own values and preferences.
Collapse
Affiliation(s)
- Otoya Sekine
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Naomi Nakano
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yoshikazu Kishino
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
- Department of Cardiovascular Medicine, Faculty of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| |
Collapse
|
7
|
Smaling HJ, Jingyuan X, Nakanishi M, Shinan-Altman S, Mehr DR, Radbruch L, Gaertner J, Werner P, Achterberg WP, van der Steen JT. Interventions that may increase control at the end of life in persons with dementia: the cross-cultural CONT-END acceptability study protocol and pilot-testing. BMC Palliat Care 2023; 22:142. [PMID: 37752467 PMCID: PMC10523619 DOI: 10.1186/s12904-023-01249-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Interventions such as advance care planning (ACP), technology, or access to euthanasia may increase the sense of control over the end of life. In people with advanced dementia, the loss of cognitive and physical function limits the ability to control care. To date, little is known about the acceptability of these interventions from the perspective of persons with dementia and others involved. This study will examine the cross-cultural acceptability, and factors associated with acceptability, of four end-of-life interventions in dementia which contain an element of striving for control. Also, we report on the development and pilot testing of animation video vignettes that explain the interventions in a standardized manner. METHODS Cross-sectional mixed-methods vignette study. We assess acceptability of two ACP approaches, technology use at the end of life and euthanasia in persons with dementia, their family caregivers and physicians in six countries (Netherlands, Japan, Israel, USA, Germany, Switzerland). We aim to include 80 participants per country, 50 physicians, 15 persons with dementia, and 15 family caregivers. After viewing each animation video, participants are interviewed about acceptability of the intervention. We will examine differences in acceptability between group and country and explore other potentially associated factors including variables indicating life view, personality, view on dementia and demographics. In the pilot study, participants commented on the understandability and clarity of the vignettes and instruments. Based on their feedback, the scripts of the animation videos were clarified, simplified and adapted to being less slanted in a specific direction. DISCUSSION In the pilot study, the persons with dementia, their family caregivers and other older adults found the adapted animation videos and instruments understandable, acceptable, feasible, and not burdensome. The CONT-END acceptability study will provide insight into cross-cultural acceptability of interventions in dementia care from the perspective of important stakeholders. This can help to better align interventions with preferences. The study will also result in a more fundamental understanding as to how and when having control at the end of life in dementia is perceived as beneficial or perhaps harmful. TRIAL REGISTRATION The CONT-END acceptability study was originally registered at the Netherlands Trial Register (NL7985) at 31 August, 2019, and can be found on the International Clinical Trials Registry Platform.
Collapse
Affiliation(s)
- Hanneke J.A. Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Xu Jingyuan
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
| | - Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - David R. Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO USA
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- Centre for Palliative Medicine, Helios Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Jan Gaertner
- Palliative Care Center Hildegard, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Wilco P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
- Center for Old Age Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| |
Collapse
|
8
|
Kondo S, Ichikawa S, Izumiya M, Eto M. Impact of value similarity on social trust in medical students: a cross-sectional web survey. BMC MEDICAL EDUCATION 2023; 23:528. [PMID: 37488587 PMCID: PMC10367362 DOI: 10.1186/s12909-023-04493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Social trust in medical students is trust in the cluster of medical students and not individual medical students. Social trust in medical students seems critical in clinical practice since citizens often face unknown medical students for the first time. However, most previous research has focused on interpersonal trust in particular medical professions, and social trust in medical students has not been addressed sufficiently. In social science, the Salient Value Similarity model has demonstrated that the value similarity between professionals and citizens is associated with social trust. This research aimed to explore the relationship between social trust in medical students and the perception of value similarity. This study also aimed to determine whether the information of medical students strengthens social trust in them. METHODS We conducted a cross-sectional study to investigate how the perception of value similarity affects social trust. The participants answered the social trust questionnaires before and after reading a brief summary of the medical education curriculum and certification via the internet in Japan. The model structure of social trust in medical students, including the perception of value similarity, was investigated using SEM. A paired t-test was used to examine the effect of informing citizens about the knowledge, skills, and professionalism requirements of students attending medical school on social trust by reading the brief summary. RESULTS The study included 658 participants, who all answered a web questionnaire. Social trust in medical students was associated with the perception of ability and value similarity. Social trust in medical students, the perception of ability, and value similarity were improved by information about medical students. CONCLUSIONS The perception of ability and value similarity seem to affect social trust in medical students. Information on medical education regarding the knowledge, skills, and professionalism of medical students may improve social trust in these students. Further research is required to sophisticate the model of social trust in medical students by exploring social trust in the medical students' supervisors in clinical settings.
Collapse
Affiliation(s)
- Satoshi Kondo
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
- Department of Medical Education, Graduate School of Medicine, University of Toyama, Toyama, Japan.
| | - Shuhei Ichikawa
- Department of General Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Clinical Simulation Center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Gastroenterology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
9
|
Mori M, Lin CP, Cheng SY, Suh SY, Takenouchi S, Ng R, Chan H, Kim SH, Chen PJ, Yuen KK, Fujimori M, Yamaguchi T, Hamano J, Kizawa Y, Morita T, Martina D. Communication in Cancer Care in Asia: A Narrative Review. JCO Glob Oncol 2023; 9:e2200266. [PMID: 37364221 PMCID: PMC10497295 DOI: 10.1200/go.22.00266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, United Kingdom
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Sayaka Takenouchi
- Department of Nursing Ethics, Division of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Raymond Ng
- Palliative and Supportive Care, Woodlands Health, Singapore, Singapore
| | - Helen Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St Mary's Hospital, Incheon, South Korea
| | - Ping-Jen Chen
- Department of Family Medicine, Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
| | - Kwok Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Hamano
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Diah Martina
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Psychosomatic and Palliative Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| |
Collapse
|
10
|
Wu YL, Yang CY, Lin TW, Shen PH, Tsai ZD, Liu CN, Hsu CC, Wang SSC, Huang SJ. Factors Impacting Advance Decision Making and Health Care Agent Appointment among Taiwanese Urban Residents after the Passage of Patient Right to Autonomy Act. Healthcare (Basel) 2023; 11:healthcare11101478. [PMID: 37239764 DOI: 10.3390/healthcare11101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
In recent years, advance care planning (ACP) promotion in Taiwan has expanded beyond clinical practice to the broader population. This study aims to investigate people's attitudes toward ACP and to identify factors influencing their signing of advance directives (ADs) and appointment of health care agents (HCAs). METHODS We identified 2337 ACP participants from consultation records between 2019 and 2020. The relationships among the participants' characteristics, AD completion, and HCA appointment were investigated. RESULTS Of 2337 cases, 94.1% completed ADs and 87.8% were appointed HCAs. Welfare entitlement (OR = 0.47, p < 0.001), the place ACP progressed (OR = 0.08, p < 0.001), the participation of second-degree relatives (OR = 2.50, p < 0.001), and the intention of not being a family burden (OR = 1.65, p = 0.010) were significantly correlated with AD completion. The probability of appointing HCAs was higher in participants with family caregiving experience (OR = 1.42, p < 0.05), who were single (OR = 1.49, p < 0.05), and who expected a good death with dignity (OR = 1.65, p < 0.01). CONCLUSIONS Our research shows that adopting ACP discussion in Taiwan is feasible, which encourages ACP conversation and facilitates AD completion. IMPLICATIONS Male and younger adults may need extra encouragement to discuss ACP matters with their families. LIMITATIONS due to sampling restrictions, our data were chosen from an urban district to ensure the integrity of the results. Furthermore, interview data could be collected in future research to supplement the quantitative results.
Collapse
Affiliation(s)
- Yi-Ling Wu
- Taipei City Hospital, Taipei 103212, Taiwan
| | - Chun-Yi Yang
- Taipei City Hospital, Taipei 103212, Taiwan
- Department of Health and Welfare, Tian-Mu Campus, College of City Management, University of Taipei, Taipei 111036, Taiwan
| | - Tsai-Wen Lin
- National Academy of Education Research, Taipei 237201, Taiwan
| | | | | | | | | | - Samuel Shih-Chih Wang
- Department of Health and Welfare, Tian-Mu Campus, College of City Management, University of Taipei, Taipei 111036, Taiwan
| | | |
Collapse
|
11
|
Takimoto Y, Nabeshima T. Ethical Healthcare Attitudes of Japanese Citizens and Physicians: Patient-Centered or Family-Centered? AJOB Empir Bioeth 2022; 14:125-134. [PMID: 36576142 DOI: 10.1080/23294515.2022.2160511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In current Western medical ethics, patient-centered medicine is considered the norm. However, the cultural background of collectivism in East Asia often leads to family-centered decision-making. In Japan, prior studies have reported that family-centered decision-making is more likely to be preferred in situations of disease notification and end-of-life decision-making. Nonetheless, there has been a recent shift from collectivism to individualism due to changes in the social structure. Various personal factors have also been reported to influence moral decision-making. Therefore, this study examined whether the current trend in attitudes of healthcare decision-making in Japan is family-centered or patient-centered among the general public and physicians. In addition, the personal factors that influence this tendency were examined. METHODS Three vignettes on disease notification and two vignettes on decision-making during end-of-life care were created, and 457 members of the public and 284 physicians were asked about their attitudes (behavioral intentions) regarding these vignettes. RESULTS Approximately, 95% of physicians were patient-centered in explaining the patient's severe medical condition. However, approximately 80% of physicians emphasized the wishes of the family over patient wishes when making life-sustaining decisions. Nearly half the general public emphasized the patient's wishes in the explanation of a severe medical condition and in life-sustaining decisions. In both the public and physician groups, personal factors, particularly the presence or absence of a disease under treatment and prior caregiving experience, influenced ethical attitudes toward medical treatment decisions. CONCLUSIONS In relatively low-conflict situations, such as the announcement of a patient's medical condition, physicians tended to be patient-centered, while they tended to be family-centered in situations of strong conflict in withholding life-sustaining treatment. The fact that personal factors influenced the family-centered response in situations of strong conflict highlights the importance of not only acquiring knowledge of medical ethics but also learning to fairly apply this knowledge in practice.
Collapse
Affiliation(s)
- Yoshiyuki Takimoto
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tadanori Nabeshima
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| |
Collapse
|
12
|
Takimoto Y. Indications for involuntary hospitalization for refusal of treatment in severe anorexia nervosa: a survey of physicians and mental health care review board members in Japan. J Eat Disord 2022; 10:176. [PMID: 36415005 PMCID: PMC9682757 DOI: 10.1186/s40337-022-00703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND When a patient with anorexia nervosa refuses treatment despite a physically critical condition, the therapist considers involuntary inpatient treatment under the Mental Health Law. However, ethical and practical problems arise from its application. In this study, a survey of treatment providers for eating disorders and psychiatric review board members was conducted regarding indications for involuntary hospitalization under the Mental Health Act for refusal of treatment for anorexia nervosa. METHODS A survey of 212 physicians affiliated with the Japanese Society for Eating Disorders and 180 members of Mental Health Care Review Boards across Japan was conducted using six vignette cases of patients with anorexia nervosa refusing treatment. RESULTS Regardless of the duration of illness or age of the patient, few physicians chose compulsory hospitalization with or without the consent of the family, while the largest number of physicians chose hospitalization for medical care and protection when there was family consent. Among committee members, only hospitalization for medical care and protection was determined to be appropriate when there was family consent. Both hospitalization for medical care and protection, and compulsory hospitalization were deemed appropriate in the absence of family consent. Committee members who adjudged refusal of treatment for anorexia nervosa as self-injurious behavior suggested that compulsory hospitalization was indicated. CONCLUSIONS When a patient with life-threatening anorexia nervosa refuses inpatient treatment, hospitalization for medical care and protection is actively chosen if the patient's family consents. Mental Health Care Review Board members considered this acceptable. However, if the family does not consent, the physicians did not choose compulsory hospitalization, and the psychiatric review board was divided on this. Consensus was not achieved in this regard.
Collapse
Affiliation(s)
- Yoshiyuki Takimoto
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Psychosomatic Medicine and Stress Science, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| |
Collapse
|
13
|
Urade M, Fujita M, Tsuchiya A, Mori K, Nakazawa E, Takimoto Y, Akabayashi A. Facts and Recommendations regarding When Medical Institutions Report Potential Abuse to Child Guidance Centers: A Cross-Sectional Study. Pediatr Rep 2022; 14:479-490. [PMID: 36412663 PMCID: PMC9680413 DOI: 10.3390/pediatric14040056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Medical institutions are required to report suspected cases of child abuse to administrative agencies, such as child guidance centers in Japan. It is left to the discretion of the medical institutions whether to notify the family of the child or the center. However, it is unclear what kinds of measures are being taken to ensure a robust policy of notification versus non-notification and how notifying the family will affect the child. METHODS An unregistered questionnaire survey on reporting suspected child abuse cases to child consultation centers and notifying families was conducted by mail across 518 pediatric specialist training facility hospitals designated by the Japanese Pediatric Society. RESULTS Responses were received from 323 facilities (62.4% response rate), of which 5 facilities were excluded because of incomplete responses. Therefore, in all, 318 facilities were included in the analysis. The results showed that 59.8% of the facilities had a policy of notifying the family, 33.7% said the decision varies from case to case, and 6.6% did not have a policy of notifying the family. The facilities that had a policy of either notifying or not notifying the family were less likely to experience problems than those with a policy of deciding on a case-by-case basis. The proportion of cases in which some problems occurred was higher in the cases where families were notified than in the cases where they were not, with 51.4% of the children experiencing worsening of relationships with family members. In the cases where the families were not notified, the children were twice as likely to experience further abuse than in cases where the families were notified. CONCLUSION Problems arise in the case of both notification and non-notification. It is necessary to examine background factors and specific methods of notification in the cases where problems arise.
Collapse
Affiliation(s)
- Mio Urade
- Department of Biomedical Ethics, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Misao Fujita
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Atsushi Tsuchiya
- Graduate School of Sociology, Kansai University, 3-3-35 Yamate-cho, Osaka 564-8680, Japan
| | - Katsumi Mori
- Department of Biomedical Ethics, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Eisuke Nakazawa
- Department of Biomedical Ethics, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yoshiyuki Takimoto
- Department of Biomedical Ethics, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Akira Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Division of Medical Ethics, School of Medicine, New York University, 227 East 30th Street, New York, NY 10016, USA
- Correspondence: or ; Fax: +81-35841-3319
| |
Collapse
|
14
|
Yamamoto K, Kaido T, Yokoi T, Shimada G, Taketa T, Nakayama K. Implementation of advance care planning decision aids for patients undergoing high-risk surgery: a field-testing study. BMC Palliat Care 2022; 21:179. [PMID: 36224540 PMCID: PMC9554854 DOI: 10.1186/s12904-022-01068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients undergoing high-risk surgery are at a risk of sudden deterioration of their health. This study aimed to examine the feasibility of the development of two patient decision aids (PtDAs) to assist patients undergoing high-risk surgeries in informed decision-making about their medical care in a crisis. METHODS This field testing implemented two PtDAs that met the international criteria developed by the researchers for patients before surgery. Study participants were patients scheduled to be admitted to the intensive care unit after surgery at one acute care hospital in Japan and their families. The study used a mixed-methods approach. The primary outcome was patients' decision satisfaction evaluated by the SURE test. Secondary outcomes were the perception of the need to discuss advance care planning (ACP) before surgery and mental health status. The families were also surveyed on their confidence in proxy decision-making (NRS: 0-10, quantitative data). In addition, interviews were conducted after discharge to assess the acceptability of PtDAs. Data were collected before (preoperative outpatients, baseline: T0) and after providing PtDAs (in the hospital: T1) and following discharge (T2, T3). RESULTS Nine patients were enrolled, of whom seven agreed to participate (including their families). The SURE test scores (mean ± SD) were 2.1 ± 1.2 (T0), 3.4 ± 0.8 (T2), and 3.9 ± 0.4 (T3). The need to discuss ACP before surgery was 8.7 ± 1.3 (T1) and 9.1 ± 0.9 (T2). The degree of confidence in family surrogate decision-making was 6.1 ± 2.5 (T0), 7.7 ± 1.4 (T1), and 8.1 ± 1.5 (T2). The patients reported that using PtDAs provided an opportunity to share their thoughts with their families and inspired them to start mapping their life plans. Additionally, patients wanted to share and discuss their decision-making process with medical professionals after the surgery. CONCLUSIONS PtDAs supporting ACP in patients undergoing high-risk surgery were developed, evaluated, and accepted. However, they did not involve any discussion of patients' ACP treatment wishes with their families. Medical providers should be coached to provide adequate support to patients. In the future, larger studies evaluating the effectiveness of PtDAs are necessary.
Collapse
Affiliation(s)
- Kanako Yamamoto
- Department of Critical Care Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.
- Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.
| | - Toshimi Kaido
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tadao Yokoi
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Gen Shimada
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Takashi Taketa
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuhiro Nakayama
- Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| |
Collapse
|
15
|
Chen DR, Jerng JS, Tsai DFC, Young Y. Gender differences in the intention to withhold life-sustaining treatments involving severe dementia for self and on behalf of parent or spouse. Palliat Care 2022; 21:171. [PMID: 36203170 PMCID: PMC9534740 DOI: 10.1186/s12904-022-01062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/26/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Few studies have explored gender differences in the attitudes toward advanced care planning and the intention to withhold life-sustaining treatments (LSTs) involving severe dementia in Asian countries. We examined gender differences in the attitude toward the Patient Autonomy Act (PAA) in Taiwan and how the gender differences in these attitudes affect the intention to withhold LSTs for severe dementia. We also investigated self–other differences in the intention to withhold LSTs between genders. Methods Between March and October 2019, a structured questionnaire was distributed to hospitalized patients’ family members through face-to-face contact in an academic medical center. Exploratory factor analysis and independent and paired-sample t-tests were used to describe gender differences. Mediation analyses controlled for age, marital status, and education level were conducted to examine whether the attitude toward the PAA mediates the gender effect on the intention to withhold LSTs for severe dementia. Results Eighty respondents filled out the questionnaire. Exploratory factor analysis of the attitude toward the PAA revealed three key domains: regarding the PAA as (1) promoting a sense of abandonment, (2) supporting patient autonomy, and (3) contributing to the collective good. Relative to the men, the women had lower average scores for promoting a sense of abandonment (7.48 vs. 8.94, p = 0.030), higher scores for supporting patient autonomy (8.74 vs. 7.94, p = 0.006), and higher scores for contributing to the collective good (8.64 vs. 7.47, p = 0.001). Compared with the women, the men were less likely to withhold LSTs for severe dementia (15.84 vs. 18.88, p = 0.01). Mediation analysis revealed that the attitude toward the PAA fully mediated the gender differences in the intention to withhold LSTs for severe dementia. Both men and women were more likely to withhold LSTs for themselves than for their parents. Compared with the women, the men were more likely to withhold resuscitation for themselves than for their parents (p = 0.05). Women were more likely to agree to enteral tube feeding and a tracheotomy for their husbands than for themselves; men made consistent decisions for themselves and their wives in those LST scenarios. Conclusion Gender influences the attitude toward advanced care planning and consequently affects the intention to withhold LSTs, indicating that there may be a difference in how men and women perceive EOL decision-making for severe dementia in Taiwan. Further studies are warranted.
Collapse
Affiliation(s)
- Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan.
| | - Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Daniel Fu-Chang Tsai
- Department & Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yuchi Young
- Department of Health Policy, Management & Behavior, School of Public Health, New York State University,, Albany, USA
| |
Collapse
|
16
|
Fujikawa H, Son D, Aoki T, Kondo K, Takemura Y, Saito M, Den N, Eto M. Translating and validating a Japanese version of the instrument for patient assessment of medical professionalism (J-IPAMP): a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:641. [PMID: 35999591 PMCID: PMC9396761 DOI: 10.1186/s12909-022-03699-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/16/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Although there are many tools to assess medical professionalism, they rarely address patients' perspectives. The instrument for patient assessment of medical professionalism (IPAMP) comprises 11 items and has been established and validated as a valuable tool for assessing trainees' professionalism from the patient's perspective. However, there is no instrument to assess professionalism from the patient's perspective in Japan. The purpose of the present study was to develop a Japanese version of the IPAMP (J-IPAMP) and test its validity and reliability. METHODS We conducted a cross-sectional survey to examine the reliability and validity of the J-IPAMP in two hospitals (one each in an urban and rural area) in Japan. Receptionists or surveyors distributed the anonymous questionnaire to 276 inpatients; all participants were aged above 20 years and assigned to medical trainees. We evaluated its structural and criterion-related validity, as well as internal consistency reliability. RESULTS Data of 235 (85.1%) patients were analyzed. Using the split-half validation technique, we performed an exploratory factor analysis (EFA) along with a confirmatory factor analysis (CFA). The EFA showed a one-factor solution. Then, to compare the model fitness between two models (the two-factor model from the original English version vs. unidimensional model suggested by the EFA), the CFA was performed. The CFA showed that almost all of the fit indices met their respective criteria and were approximately the same for the two models. Thus, we adopted a single-factor model. The Pearson correlation coefficients between the total J-IPAMP scores and the global ratings were 0.738, indicating adequate criterion-related validity. The Cronbach's alpha of the 11 items of the instrument was 0.96 (95% confidence interval: 0.96-0.97) and the omega value was 0.96, demonstrating acceptable internal consistency reliability. CONCLUSIONS We developed the Japanese version of the IPAMP. Its validity and reliability were verified through analysis. This instrument can be utilized for professionalism education in the postgraduate training setting.
Collapse
Affiliation(s)
- Hirohisa Fujikawa
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Kayo Kondo
- School of Modern Languages and Cultures, Durham University, Durham, UK
| | - Yousuke Takemura
- Department of General Medicine, Graduate School of Medical Science, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Minoru Saito
- Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan
| | - Naoko Den
- Department of Internal Medicine, Oji Seikyo Hospital, Tokyo Hokuto Health Co-Operative, Kita-ku, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|
17
|
Psychosocial and Ethical Behaviors and Attitudes of Health Care Professionals in the Clinical Setting of Living Kidney Donors: A Qualitative Study. Transplant Proc 2022; 54:1750-1758. [PMID: 35985877 DOI: 10.1016/j.transproceed.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are several psychosocial and ethical issues surrounding the decision making of living kidney transplant donors. This study aimed to determine what health care professionals (HPs) consider in their clinical practice and their attitudes toward donors' decision-making processes. METHODS Face-to-face semistructured interviews were conducted with 15 HPs. A thematic analysis was performed to categorize the thematic elements of the transcripts. All procedures were approved by the relevant review board and conducted in accordance with the Declaration of Helsinki. RESULTS Six main categories-maintaining family relationships, improving donor understanding, supporting voluntary decision making, setting the environment for the examination, having different attitudes toward the donor's intentions, and resisting confirmation of intent-were identified. The HPs provided diverse considerations to respect the donors' autonomy. CONCLUSION In clinical practice, there is a lack of practical methods to confirm living donors' levels of understanding and spontaneity, suggesting that these methods need to be established. Factors related to family functioning may reflect the unique culture of Japan, and this may be indicative of the need to consider treatment based on cultural values.
Collapse
|
18
|
Autonomy in Japan: What does it Look Like? Asian Bioeth Rev 2022; 14:317-336. [PMID: 36203709 PMCID: PMC9530074 DOI: 10.1007/s41649-022-00213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
This paper analysed the nature of autonomy, in particular respect for autonomy in medical ethics/bioethics in Japan. We have undertaken a literature survey in Japanese and English and begin with the historical background and explanation of the Japanese word Jiritsu (autonomy). We go on to identify patterns of meaning that researchers use in medical ethics / bioethics discussions in Japan, namely, Beauchamp and Childress’s individual autonomy, relational autonomy, and O’Neill’s principled autonomy as the three major ways that autonomy is understood. We examine papers discussing these interpretations. We propose using the term ‘a form of autonomy’ first used by Edmund Pellegrino in 1992 and examine the nature of ‘a form of autonomy.’ We finally conclude that the crux of what Pellegrino calls ‘something close to autonomy,’ or ‘a form of autonomy' might best be understood as the minimization of physician paternalism and the maximization of respect for patient preference. Simultaneously, we introduce a family-facilitated approach to informed consent and respond to criticism by Laura Sullivan. Finally, we discuss cross-cultural approaches and global bioethics. Furthermore, we use the term ‘Bioethics across the Globe’ instead of ‘Global Bioethics’, calling for international scholars to write works to provide an in-depth understanding of each country. We conclude that deep understanding of others is pivotal for dialogue to be of value. We hope this article will deepen the reader’s understanding of Japan and will contribute to the progress of bioethics worldwide.
Collapse
|
19
|
Takimoto Y. International comparison of physicians' attitudes toward refusal of treatment by patients with anorexia nervosa: a case-based vignette study. J Eat Disord 2022; 10:86. [PMID: 35739606 PMCID: PMC9230079 DOI: 10.1186/s40337-022-00613-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the attitudes of physicians in Japan, the United Kingdom (UK), and the United States (US) toward refusal of treatment for anorexia nervosa. METHODS A questionnaire survey was administered to physicians treating patients with eating disorder (Japan, n = 55; UK, n = 84; US, n = 82) to evaluate their treatment strategies for fictitious cases of refusal of treatment for anorexia nervosa. RESULTS For acute patients, 53 (96.3%) physicians in Japan, 65 (77.4%) in the UK, and 54 (65.9%) in the US chose compulsory treatment if the patient's family requested treatment, while 46 (83.6%) physicians in Japan, 53 (63.1%) in the UK, and 47 (57.3%) in the US chose compulsory treatment if the family left the decision to the patient. For severe and enduring anorexia nervosa, 53 (96.3%) physicians in Japan, 62 (73.8%) in the UK, and 57 (69.5%) in the US chose compulsory treatment if the patient's family requested treatment, while 38 (69.1%) physicians in Japan, 56 (66.7%) in the UK, and 55 (67.1%) in the US chose compulsory treatment if the family left the decision to the patient. CONCLUSIONS Physicians in all three countries tended to choose compulsory treatment irrespective of disease duration or whether the patient's family requested treatment or not. This may indicate that medical practitioners value the ethical obligation of beneficence, giving priority to the protection of life. Attitudes toward refusal of treatment during a life crisis tend to vary among medical professionals, particularly if the patient's family does not request treatment.
Collapse
Affiliation(s)
- Yoshiyuki Takimoto
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Psychosomatic Medicine and Stress Science, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| |
Collapse
|
20
|
Chikada A, Takenouchi S, Nin K, Mori M. Definition and Recommended Cultural Considerations for Advance Care Planning in Japan: A Systematic Review. Asia Pac J Oncol Nurs 2021; 8:628-638. [PMID: 34790847 PMCID: PMC8522591 DOI: 10.4103/apjon.apjon-2137] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022] Open
Abstract
Although Delphi studies in Western countries have provided a consensus for practices pertaining to advance care planning (ACP), their findings may not be applicable to Asian countries with distinct, family-oriented cultures. This systematic review aimed to synthesize the definitions of and evidence for ACP and analyze recommended practices in Japan. We conducted a systematic review using narrative synthesis in December 2018. Key words were searched from Ichushi-Web by NPO Japan Medical Abstracts Society, Citation Information by the National Institute of Informatics, and Japanese Institutional Repositories Online databases. In addition, in August 2019, we conducted hand searching using Google Scholar and Google. We included original Japanese articles that addressed factors regarding ACP (e.g. definitions, elements, roles and tasks, and timing of ACP). Data were synthesized using thematic analysis. The study protocol was registered prospectively (PROSPERO: CRD42020152391). Of the 3,512 studies screened, 27 were included: 22 quantitative and 5 qualitative. Five-position statements/guidelines were added by hand searching. Definitions and several distinct practice patterns of ACP and the importance of families' roles were identified. Unique recommendations addressed the importance of properly eliciting patients' preferences that are the best for both patients and families, engaging the public to raise awareness of ACP, and developing policies and guidelines for ACP. We identified the definition of and unique recommendations for ACP based on Japanese cultural values and norms. Further research is needed to evaluate the recommendations provided in this systematic review.
Collapse
Affiliation(s)
- Ai Chikada
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Takenouchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuko Nin
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| |
Collapse
|
21
|
Matsukawa M, Torishima M, Satoh C, Honda S, Kosugi S. Japanese women's reasons for accompaniment status to hereditary breast and ovarian cancer-focused genetic counseling. J Genet Couns 2021; 31:497-509. [PMID: 34661949 DOI: 10.1002/jgc4.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022]
Abstract
Genetic counselors routinely assess and understand clients' needs at the beginning of a session. Attending a genetic counseling session with or without companions is an objective sign that genetic counselors can easily notice. This study focused on clients' reasons for their accompaniment status for genetic counseling, which we categorize into attending with or without a companion(s). A questionnaire survey and interviews were conducted using snowball sampling, starting with the chief executive officer (CEO) of the Japanese hereditary breast and ovarian cancer (HBOC) support group. Of 32 participants, 19 continued with an in-depth interview after answering the questionnaire. Five themes were identified from the interview: (1) personal confidence, (2) decision-making style, (3) family members' habits and time availability, (4) considerations and conflicts with family members, and (5) healthcare provider's suggestion. Our data suggested that the clients expected their companion(s) to play certain roles. This indicates that the reasons of accompaniment status will be helpful for genetic counselors to understand both clients' and their families' motivations, personalities, habits, and psychosocial backgrounds. In a high-context culture such as that of Japan, accompaniment status may be a helpful sign to understand clients' true worries. In addition, some companions may be future clients in genetic counseling, due to the genetic nature of the disease. In conclusion, our study indicated that it is important for genetic counselors to record accompaniment status before the initial genetic counseling and to pay attention to its reasons at the beginning of the session, which may lead them to understand the client's psychosocial background to facilitate better client-centered genetic counseling.
Collapse
Affiliation(s)
- Manami Matsukawa
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masako Torishima
- Department of Genomic Medicine, Kyoto University School of Public Health, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Chika Satoh
- Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan
| | - Sayaka Honda
- Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
22
|
Abe M, Tsunawaki S, Dejonckheere M, Cigolle CT, Phillips K, Rubinstein EB, Matsuda M, Fetters MD, Inoue M. Practices and perspectives of primary care physicians in Japan and the United States about diagnosing dementia: a qualitative study. BMC Geriatr 2021; 21:540. [PMID: 34635089 PMCID: PMC8503990 DOI: 10.1186/s12877-021-02457-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. METHODS Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. RESULTS Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. CONCLUSIONS Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.
Collapse
Affiliation(s)
- M Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Hamamatsu, Japan
| | - S Tsunawaki
- Omaezaki Family Medicine Center, Shizuoka, Omaezaki, Japan
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
| | - M Dejonckheere
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA
| | - C T Cigolle
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System (VAAHS) Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
| | - K Phillips
- VA Ann Arbor Healthcare System (VAAHS) Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
| | - E B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, North Dakota, USA
| | - M Matsuda
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
- Kikugawa Family Medicine Center, Shizuoka, Kikugawa, Japan
| | - M D Fetters
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA.
- The School of Health Humanities, Peking University Health Science Center, Beijing, China.
| | - M Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Hamamatsu, Japan
| |
Collapse
|
23
|
Tanaka M, Bito S, Enzo A, Okita T, Atsushi A. Cross-sectional survey of surrogate decision-making in Japanese medical practice. BMC Med Ethics 2021; 22:128. [PMID: 34560873 PMCID: PMC8464150 DOI: 10.1186/s12910-021-00698-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Instances of surrogate decision-making are expected to increase with the rise in hospitalised older adults in Japan. Few large-scale studies have comprehensively examined the entire surrogate decision-making process. This study aimed to gather information to assess the current state of surrogate decision-making in Japan. METHODS A cross-sectional survey was conducted using online questionnaires. A total of 1000 surrogate decision-makers responded to the questionnaire. We examined the characteristics of surrogate decision-makers and patients, content of surrogate decision-making meeting regarding life-sustaining treatment between the doctors and surrogate decision-makers, extent of involvement of the various parties in the surrogate decision-making process, judgement grounds for surrogate decision-making, and frequency of involvement in the surrogate decision-making process. RESULTS Of the participants, 70.5% were male and 48.3% were eldest sons. Only 7.6% of the patients had left a written record of their preferences and 48.8% of the surrogates reported no knowledge of the patient having expressed their prior intentions regarding medical care in any form. Respondents indicated that their family meetings with healthcare professionals mostly included the information recommended by guidelines in a surrogate decision-making meeting in Japan. Most participants reported a good understanding of the meeting content. Although many participants based their decisions on multiple grounds, surrogates' considerations may not adequately reflect respect for patient autonomy in Japan. Specifically, the eldest son considered his own preference more frequently than that of the other surrogate decision-makers. In 26.1% of the cases, either zero or one family meeting with healthcare professionals was held. In these cases, significantly fewer decisions involved the participation of healthcare professionals other than the doctor compared to cases with multiple meetings. CONCLUSIONS Surrogate decisions in Japan are most commonly made by eldest sons and may not frequently consider the perspectives of other surrogates. The finding that patient preferences were rarely known suggests a role for increased advance care planning.
Collapse
Affiliation(s)
- Masashi Tanaka
- Department of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan. .,Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Seiryotyou, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. .,KARADA Internal Medicine Clinic Shibuya, 1-23-13 Jinnan, Shibuya-ku, Tokyo, 150-0041, Japan.
| | - Seiji Bito
- Department of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Aya Enzo
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Seiryotyou, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Takethoshi Okita
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Seiryotyou, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Asai Atsushi
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Seiryotyou, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| |
Collapse
|
24
|
Kosaka M, Miyatake H, Kotera Y, Masunaga H, Arita S, Tsunetoshi C, Nishikawa Y, Ozaki A, Beniya H. The survival time of end-of-life home care patients in Fukui prefecture, Japan: A retrospective observational study. Medicine (Baltimore) 2021; 100:e27225. [PMID: 34559116 PMCID: PMC10545356 DOI: 10.1097/md.0000000000027225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT End-of-life advance care planning (ACP) has become increasingly important in home care setting. In facilitating ACP discussion in home care setting, accurate understanding of patients' survival would be beneficial because it would facilitate healthcare professionals to individualize ACP discussion. However, little is known about survival outcome of home care patients. This study aimed to clarify the outcome of patients and identify factors to better predict the survival outcome of home care patients with the focus on patients' primary diseases.We conducted a retrospective analysis using data from 277 patients managed at a home care clinic in Japan and first treated in 2017 or 2018. Data regarding sociodemographic and clinical characteristics, and clinical outcome on December 31, 2019 were extracted. Using Kaplan-Meier product-limit method, we estimated the overall 30 days, 90 days, 1 year, and 3 year survival probabilities among the entire patients and their differences according to their primary disease. We also evaluated whether outcomes differed based on the primary disease or other factors using the hazard ratio and Cox proportional hazards regression.The overall survival probability was 82.5% at 30 days, 67.8% at 90 days, 52.7% at 1 year, and 39.1% at 3 years. The survival rates at 30 days, 90 days, 1 year, and 3 years were 64.6%, 33.4%, 9.5%, and 4.1% among cancer patients; 91.9%, 86.4%, 78.1%, and 47.0% among dementia patients; and 91.9%, 86.4%, 78.1%, and 47.0% among patients with other nervous and cerebrovascular diseases, respectively. Cox proportional hazard regression clarified that cancer patients (hazard ratio 6.53 [95% CI 4.16-10.28]) and older adults (hazard ratio 1.01 [95% CI 1.00-1.02]) were significantly more likely to die than dementia patients and young patients, respectively.Primary disease had a significant influence on the prediction of survival time and could be a useful indicator to individualize ACP in home care setting.
Collapse
Affiliation(s)
- Makoto Kosaka
- Orange Home-Care Clinic, Fukui City, Fukui Prefecture, Japan
| | | | | | | | - Satoshi Arita
- Orange Home-Care Clinic, Fukui City, Fukui Prefecture, Japan
| | - Chie Tsunetoshi
- Orange Home-Care Clinic, Fukui City, Fukui Prefecture, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Akihiko Ozaki
- Orange Home-Care Clinic, Fukui City, Fukui Prefecture, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Fukushima Prefecture, Japan
| | - Hiroyuki Beniya
- Orange Home-Care Clinic, Fukui City, Fukui Prefecture, Japan
| |
Collapse
|
25
|
Shaku F, Yada Y, Tsutsumi M, Kim WS. Characterising end-of-life decision-making of life-sustaining treatment among Japanese nurses. Int J Palliat Nurs 2021; 27:213-218. [PMID: 34169740 DOI: 10.12968/ijpn.2021.27.4.213] [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: 11/11/2022]
Abstract
BACKGROUND Often, nurses are closer to end-of-life (EOL) patients than other medical professionals, due to the time they spend with them at their bedside, which leads them to understand patients' care goals. AIMS To investigate the importance of EOL preferences by examining nurses' EOL decision-making regarding life-sustaining treatment (LST). METHODS In this cross-sectional study, 559 self-reported questionnaires of Japanese nurses were examined. Marital status, age and decision-making regarding LST for themselves were investigated. FINDINGS Unmarried participants from all age groups had a higher percentage of 'no preference for LST' than married groups. Differences between the percentages were higher in the 20s age group. Married participants increasingly preferred to receive no LST as their age increased, unlike single participants. CONCLUSION Marital status influences Japanese nurses' EOL decision-making regarding LST. Therefore, it is necessary to consider a patient's marital status to facilitate better decision-making.
Collapse
Affiliation(s)
- Fumio Shaku
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan; Department of Psychosomatic Internal Medicine, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yoichi Yada
- Division of Pharmacology, Nihon University School of Medicine, Tokyo, Japan
| | | | - Woe Sook Kim
- College of Nursing Art and Science, University of Hyogo, Japan
| |
Collapse
|
26
|
Ma D, Zuo M, Liu L. The Information Needs of Chinese Family members of Cancer Patients in the Online Health Community: What and Why? Inf Process Manag 2021. [DOI: 10.1016/j.ipm.2021.102517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
27
|
Tomita S, Kuga T, Osugi Y, Kobayashi D. Factors associated with the accomplishment of home death among patients receiving physician-led home healthcare. Geriatr Gerontol Int 2021; 21:525-531. [PMID: 33904229 DOI: 10.1111/ggi.14173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate unique factors associated with home death in older Asian individuals who received physician-led home healthcare. METHODS We carried out a case-control study at a single hospital in Japan from February 2018 to December 2019. We included patients who had started receiving physician-led home healthcare and died at home as cases, and those receiving the same type of care but died in the hospital as controls. Multivariable logistic regression was used to evaluate factors associated with home death. RESULTS A total of 152 patients (mean age 70.3 years [SD 11.2 years]; 86 [56.6%] men) were included, of whom 89 (58.6%) died at home and 63 (41.4%) died in the hospital. Comparing the two groups, the presence of family psychological problems related to care was significantly more common in the hospital death group (home death 49.4%; hospital death 32.3%, P = 0.036). Home death was related to patients aged >85 years compared with patients aged <75 years (adjusted odds ratio 6.47, 95% CI 1.52-27.48) and patients who were in the highest quartile of the number of symptoms (adjusted odds ratio 5.45, 95% CI 1.15-25.95) compared with the lowest. Family members' willingness for the patient to die at home was associated with home death (adjusted odds ratio 7.47, 95% CI 2.13-26.19). CONCLUSIONS Older age and multiple symptoms were related to accomplishing home death. Patient preference was not associated with the place of death, but family member preference was. These results might reflect family concepts particular to Asia. Geriatr Gerontol Int 2021; 21: 525-531.
Collapse
Affiliation(s)
- Shiori Tomita
- General Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Takao Kuga
- General Medicine, Toyota Regional Medical Center, Toyota, Japan
| | - Yasuhiro Osugi
- Community Based Medicine, Fujita Health University, Toyoake, Japan
| | - Daiki Kobayashi
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| |
Collapse
|
28
|
Carey ML, Uchida M, Zucca AC, Okuyama T, Akechi T, Sanson-Fisher RW. Experiences of Patient-Centered Care Among Japanese and Australian Cancer Outpatients: Results of a Cross-Sectional Study. J Patient Exp 2021; 8:23743735211007690. [PMID: 34179419 PMCID: PMC8205376 DOI: 10.1177/23743735211007690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
There have been few international comparisons of patient-centered cancer care delivery. This study aimed to compare the experiences of patient-centered care (PCC) of Japanese and Australian radiation oncology patients. Participants were adults with cancer attending a radiotherapy appointment at a Japanese or Australian clinic. Participants completed a survey asking about 10 indicators of PCC. Overall, 259 Japanese and 285 Australian patients participated. Compared with Japanese participants, Australian participants were significantly more likely to report receiving information about: what the treatment is, and the short-term and long-term side effects of treatment. A higher proportion of Australian participants reported being asked whether they wanted a friend or family member present at the consultation. There were no differences in the frequency with which Japanese and Australian participants were asked by their clinicians about whether they were experiencing physical side effects or emotional distress. International differences highlight the (1) need to exercise caution when generalizing from one country to another; and (2) the importance of context in understanding PCC delivery and the subsequent design of quality improvement interventions.
Collapse
Affiliation(s)
- Mariko L Carey
- Health Behavior Research Collaborative, Faculty of Health and
Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan,
New South Wales, Australia
- Priority Research Centre for Health Behavior, University of
Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South
Wales, Australia
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya
City University Graduate School of Medical Sciences, Nagoya, Japan
- Division of Palliative Care and Psycho-oncology, Nagoya City
University Hospital, Nagoya, Japan
| | - Alison C Zucca
- Health Behavior Research Collaborative, Faculty of Health and
Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan,
New South Wales, Australia
- Priority Research Centre for Health Behavior, University of
Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South
Wales, Australia
| | - Toru Okuyama
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya
City University Graduate School of Medical Sciences, Nagoya, Japan
- Division of Palliative Care and Psycho-oncology, Nagoya City
University Hospital, Nagoya, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya
City University Graduate School of Medical Sciences, Nagoya, Japan
- Division of Palliative Care and Psycho-oncology, Nagoya City
University Hospital, Nagoya, Japan
| | - Rob W Sanson-Fisher
- Health Behavior Research Collaborative, Faculty of Health and
Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan,
New South Wales, Australia
- Priority Research Centre for Health Behavior, University of
Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South
Wales, Australia
| |
Collapse
|
29
|
Ewuoso C, Hall S, Dierickx K. How do healthcare professionals respond to ethical challenges regarding information management? A review of empirical studies. Glob Bioeth 2021; 32:67-84. [PMID: 33897255 PMCID: PMC8023626 DOI: 10.1080/11287462.2021.1909820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim This study is a systematic review that aims to assess how healthcare professionals manage ethical challenges regarding information within the clinical context. Method and Materials We carried out searches in PubMed, Google Scholar and Embase, using two search strings; searches generated 665 hits. After screening, 47 articles relevant to the study aim were selected for review. Seven articles were identified through snowballing, and 18 others were included following a system update in PubMed, bringing the total number of articles reviewed to 72. We used a Q-sort technique for the analysis of identified articles. Findings This study reveals that healthcare professionals around the world generally employ (to varying degrees) four broad strategies to manage different types of challenges regarding information, which can be categorized as challenges related to confidentiality, communication, professional duty, and decision-making. The strategies employed for managing these challenges include resolution, consultation, stalling, and disclosure/concealment. Conclusion There are a variety of strategies which health professionals can adopt to address challenges regarding information management within the clinical context. This insight complements current efforts aimed at enhancing health professional-patient communication. Very few studies have researched the results of employing these various strategies. Future empirical studies are required to address this. Abbreviations CIOMS: Council of International Organization of Medical Sciences; WHO: World Health Organization; AMA: American Medical Association; WMA: World Medical Association; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; ISCO: International Standard Classification of Occupations; ILO: International Labour Office; SPSS: The Statistical Package for the Social Sciences
Collapse
Affiliation(s)
| | - Susan Hall
- Center for Applied Ethics, Stellenbosch University, Western-Cape, South Africa
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
30
|
Alami LSEE, Nemoto A, Nakata Y. Investigation of users' experiences for online access to their electronic health records in Japan. Glob Health Med 2021; 3:37-43. [PMID: 33688594 DOI: 10.35772/ghm.2020.01073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022]
Abstract
The solution of sharing electronic health records (EHR) with patients has the potential to improve patients' understanding and remembering of their health information. We call this solution the patient open-EHR. In Japan, this solution is not yet widespread, and experiences of actual users are not known. Our aim is to explore the needs and satisfaction of patients who are actually using one patient open-EHR system in Japan that allows registered patients online access to part of their EHR. A cross-sectional study was done using an online questionnaire. Patients registered with our patient open-EHR system were invited to participate by posting an invitation message on the system login page and sending them invitation emails. We investigated their needs regarding the system and their views regarding the system's ability to improve their understanding, remembering, and other perspectives. Answers from 95 patients, collected between August 10 and October 20, 2019 were analyzed. The need to further understand and remember the information received from the doctor was among the top four reasons behind using the system. However, only 48% of patients agreed that the system improved their remembering and 68% agreed that it improved their understanding. Thirty-seven percent of respondents expressed dissatisfaction with access to only blood test results and prescriptions. Despite this dissatisfaction, respondents were positive about the future of the system. Hospitals need to recognize the needs of patients and to consider them when providing patient open-EHR service. The EHR has potential not only for hospitals but also for patients.
Collapse
Affiliation(s)
| | - Asuka Nemoto
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Yoshinori Nakata
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| |
Collapse
|
31
|
Advance Care Planning in Asia: A Systematic Narrative Review of Healthcare Professionals’ Knowledge, Attitude, and Experience. J Am Med Dir Assoc 2021; 22:349.e1-349.e28. [DOI: 10.1016/j.jamda.2020.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
|
32
|
Chikada A, Takenouchi S, Nin K, Mori M. Definition and recommended cultural considerations for advance care planning in Japan: A systematic review. Asia Pac J Oncol Nurs 2021. [DOI: 10.4103/apjon.apjon_2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
33
|
Akiyama N, Fujisawa T, Morita T, Mori K, Yasui H, Hozumi H, Suzuki Y, Karayama M, Furuhashi K, Enomoto N, Nakamura Y, Inui N, Suda T. Palliative Care for Idiopathic Pulmonary Fibrosis Patients: Pulmonary Physicians' View. J Pain Symptom Manage 2020; 60:933-940. [PMID: 32569830 DOI: 10.1016/j.jpainsymman.2020.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT Although idiopathic pulmonary fibrosis (IPF) has worse outcomes compared with most malignancies, patients with IPF receive poor access to optimal palliative care. OBJECTIVES This study aimed to characterize the practice of pulmonologists regarding palliative care and end-of-life communication for patients with IPF and identify perceived difficulties and barriers thereto. METHODS Self-administered questionnaires were sent by mail to representative pulmonologists from Shizuoka prefecture, Japan. Physician-reported practice, difficulties, timing of end-of-life communication, and barriers related to palliative care were investigated. RESULTS Among the 135 participants, 130 (96%) completed the questionnaire. Most of the participants reported that patients with IPF complained of dyspnea and cough. However, less morphine was prescribed for IPF than for lung cancer. The participants experienced greater difficulty in providing palliative care for IPF than for lung cancer. Moreover, actual end-of-life discussions in patients with IPF were conducted later than the physician-perceived ideal timing. Among the barriers identified, few established treatment and difficulty in predicting prognosis (odds ratio [OR] 2.0; P = 0.04), discrepancies in understanding and care goals among patients, family, and medical staff (OR 2.2; P = 0.03), and inadequate communication about goal of care (OR 2.3; P = 0.003) were significantly associated with the physician-perceived difficulties in providing palliative care for patients with IPF. CONCLUSION Pulmonologists experienced greater difficulty in providing palliative care to patients with IPF than to those with lung cancer. Clinical studies on the optimal palliative care for patients with IPF are urgently required.
Collapse
Affiliation(s)
- Norimichi Akiyama
- Department of Pulmonary Medicine, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Tatsuya Morita
- Department of Palliative Care Medicine, Seirei Mikahahara General Hospital, Hamamatsu, Japan
| | - Kazutaka Mori
- Department of Pulmonary Medicine, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
34
|
Zaki P, Shenoy G, Gou J, Raj V, Howell K. Radiation Oncologist Perceptions and Utilization of Digital Patient Assessment Platforms. APPLIED RADIATION ONCOLOGY 2020; 9:24-29. [PMID: 33024796 PMCID: PMC7536100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patient engagement is increasing in the presence of digital patient assessment platforms, or physician rating websites. Despite this rapid growth, data remains insufficient regarding how these evaluations impact radiation oncologists. OBJECTIVES The purpose of this study was to assess radiation oncologists worldwide on their awareness and noted effects of digital patient assessment platforms. METHODS An electronic survey was delivered to 6,199 members of the American Society of Radiation Oncology. Subjects were radiation oncologists practicing throughout the world. The survey consisted of 14 questions focused on demographics, practice details, patient volume, institutional utilization of patient reviews, and perceptions of radiation oncologists on health care reviews provided by patients. RESULTS There were 447 responses from practicing radiation oncologists in total, 321 (72%) of which are in the US. Most respondents (228; 51%) either agreed or strongly agreed that patients consider online reviews when deciding which physician to visit. Of all respondents, 188 (42%) reported that their institution checks their online feedback, whereas 157 (36%) and 99 (22%) respectively reported not knowing, or to their knowledge their institution does not check their online feedback. Respondents who saw more than the average number of consults per week were significantly more likely to receive negative feedback (P = 0.005). Forty-five percent of respondents agreed or strongly agreed that online virtual assessment tools contribute to physician burnout. Respondents (100; 22%) who received inappropriate or misdirected feedback were significantly more likely to report that virtual reviews contribute to burnout (P = 0.001). CONCLUSIONS Radiation oncologists need to be aware that self-reported patient assessments are a data point in the quality of a physician and health care establishment. To best ensure appropriate feedback of a physician's capabilities as a doctor, leadership and employee alignment for patient experience are now more important than ever.
Collapse
Affiliation(s)
- Peter Zaki
- Department of Radiation Oncology, University of Washington, Seattle, and previously at Penn State College of Medicine, Hershey, PA
| | | | - Jiangtao Gou
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA
| | - Vijay Raj
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center
| |
Collapse
|
35
|
Okuhara T, Okada H, Kiuchi T. Examining persuasive message type to encourage staying at home during the COVID-19 pandemic and social lockdown: A randomized controlled study in Japan. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30443-2. [PMID: 32863098 PMCID: PMC7442015 DOI: 10.1016/j.pec.2020.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/22/2020] [Accepted: 08/13/2020] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Behavioral change is the only prevention against the COVID-19 pandemic until vaccines become available. This is the first study to examine the most persuasive message type in terms of narrator difference in encouraging people to stay at home during the COVID-19 pandemic and social lockdown. METHODS Participants (n = 1,980) were randomly assigned to five intervention messages (from a governor, a public health expert, a physician, a patient, and a resident of an outbreak area) and a control message. Intention to stay at home before and after reading messages was assessed. A one-way ANOVA with Tukey's or Games-Howell test was conducted. RESULTS Compared with other messages, the message from a physician significantly increased participants' intention to stay at home in areas with high numbers of people infected (versus a governor, p = .002; an expert, p = .023; a resident, p = .004). CONCLUSION The message from a physician-which conveyed the crisis of overwhelmed hospitals and consequent risk of people being unable to receive treatment-increased the intent to stay at home the most. PRACTICE IMPLICATIONS Health professionals and media operatives may be able to encourage people to stay at home by disseminating the physicians' messages through media and the internet.
Collapse
Affiliation(s)
- Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroko Okada
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
36
|
Su T, He C, Li X, Xiao L, He J, Bai Y, Tang Y. Association between early informed diagnosis and survival time in patients with lung cancer. Psychooncology 2020; 29:878-885. [PMID: 32266740 DOI: 10.1002/pon.5360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/07/2020] [Accepted: 02/10/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE As a malignant tumor with high mortality, lung cancer (LC) often causes great trauma to patients, and a series of negative emotions and a heavy psychological burden accompanies poor prognosis. Whether or not to inform the patients of their condition has always been a controversial topic in the medical community. This retrospective cohort study investigated the association between early informed diagnosis and survival time in patients with LC. METHODS A total of 29 825 patients with LC were enrolled between October 2002 and December 2016. The potential factors influencing LC survival were registered, including knowing their cancer diagnosis status, age, gender, pathological type, clinical stage, surgical history, hospital grade, and patient occupation. All participants were followed up every 6 months until June 2017. RESULTS In June 2017, 23.1% of the participants still survived. Their median survival time (MST) was 11.20 months (95% confidence interval [CI], 10.98-11.43). Generally, patients that knew their cancer diagnosis had longer MST than those who did not (18.33 months vs 8.77 months, P < .001). By stratified analysis, patients that knew their cancer diagnosis had longer survival time in each subgroup (P < .001, all subgroups). Cox regression analysis showed that knowing their cancer diagnosis was an independent influencing factor for survival in patients with LC (hazard ratio, 0.826; 95% CI, 0.802-0.851; P < .001). CONCLUSIONS Knowing their cancer diagnosis contributed to longer survival time in patients with LC, providing clear evidence that medical staff and patients' families should fully disclose cancer diagnoses to patients.
Collapse
Affiliation(s)
- Tong Su
- College of Psychology, The Second Military Medical University, Shanghai, China.,Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Chen He
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Xiaopan Li
- Department of Cancer Prevention and Vital Statistics, Center for Disease Control and Prevention, Shanghai, China.,Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Lei Xiao
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Jingwen He
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Yonghai Bai
- Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Yunxiang Tang
- College of Psychology, The Second Military Medical University, Shanghai, China.,Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| |
Collapse
|
37
|
Fine A, Fontaine B, Kraushar MM, Rich BR. Nephrologists Should Voluntarily Divulge Survival Data to Potential Dialysis Patients: A Questionnaire Study. Perit Dial Int 2020. [DOI: 10.1177/089686080502500310] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background For many dialysis patients, survival is no different than with certain cancers. Yet, it appears that most nephrologists do not give detailed information about survival prior to obtaining informed consent for chronic dialysis. There are no published data on whether patients wish to be so informed. Objective To assess whether patients would want voluntary disclosure by their physician of their survival should they need dialysis, and if so, why? Method A questionnaire was completed by 100 general nephrology patients during their first visit to a nephrologist. Results The vast majority of patients (97%) would want to be given life-expectancy information, and for the physician to do so without having to be prompted. Furthermore, the majority of patients would want as much information as possible, both good and bad. Conclusions Virtually all patients want, and therefore should receive from their physician, prognostic information about dialysis to facilitate informed decision-making. This is in accordance with current practice guidelines.
Collapse
Affiliation(s)
- Adrian Fine
- Section of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bunny Fontaine
- Section of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Beverly R. Rich
- Section of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
38
|
Widell C, Andréen S, Albertsson P, Axelsson ÅB. Octogenarian preferences and expectations for acute coronary syndrome treatment. Eur J Cardiovasc Nurs 2020; 19:521-528. [DOI: 10.1177/1474515120902315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The number of elderly persons with cardiovascular disease is increasing. In Sweden, the incidence of acute myocardial infarction is the highest among individuals aged 85 years and over. However, there is still little evidence about whether this population benefits from established treatments. Furthermore, the values and preferences of octogenarians (age ⩾80 years), as well as how they could be involved in treatment decisions, have been largely overlooked in research. Overall, increased knowledge about the preferences and expectations of octogenarians is needed to incorporate their treatment expectations into the decision-making process. Aims: This study aimed to describe the treatment choice preferences and post-treatment life expectations of octogenarians with acute coronary syndrome. Methods: A total of 19 patients (eight women, 11 men) aged 80 years and older and diagnosed with non-ST-elevation myocardial infarction or unstable angina were enrolled in this qualitative study. Data were collected between May 2011 and June 2013 through semistructured interviews. The data were analysed using qualitative content analysis. Results: We identified two main categories: Wanting the best and Hope for increased wellbeing. Participant preferences were influenced by their own and others’ previous experiences and their confidence in healthcare professionals. With respect to treatment outcomes, the participants hoped to get well, stay active, experience fewer symptoms and regain vitality. Conclusion: The studied octogenarians desired the best treatment option and trusted that their healthcare providers will make appropriate recommendations. These patients expected their treatment to result in increased wellbeing and fewer symptoms.
Collapse
Affiliation(s)
- Charlotte Widell
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Sofie Andréen
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa B Axelsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Kua CH, Reeve E, Tan DSY, Koh T, Soong JL, Sim MJL, Zhang TY, Chen YR, Ratnasingam V, Mak VSL, Lee SWH. Patients’ and Caregivers’ Attitudes Toward Deprescribing in Singapore. J Gerontol A Biol Sci Med Sci 2020; 76:1053-1060. [DOI: 10.1093/gerona/glaa018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Indexed: 01/01/2023] Open
Abstract
Abstract
Background
Knowledge of decision-making preference of patients and caregivers is needed to facilitate deprescribing. This study aimed to assess the perspectives of caregivers and older adults towards deprescribing in an Asian population. Secondary objectives were to identify and compare characteristics associated with these attitudes and beliefs.
Method
A cross-sectional survey of two groups of participants was conducted using the Revised Patients’ Attitudes Towards Deprescribing questionnaire. Descriptive results were reported for participants’ characteristics and questionnaire responses from four factors (belief in medication inappropriateness, medication burden, concerns about stopping, and involvement) and two global questions. Correlation between participant characteristics and their responses was analyzed.
Results
A total of 1,057 (615 older adults; 442 caregivers) participants were recruited from 10 institutions in Singapore. In which 511 (83.0%) older adults and 385 (87.1%) caregivers reported that they would be willing to stop one or more of their medications if their doctor said it was possible, especially among older adults recruited from acute-care hospitals (85.3%) compared with older adults in community pharmacies (73.6%). Individuals who take more than five medications and those with higher education were correlated with greater agreement in inappropriateness and involvement, respectively.
Conclusions
Clinicians should consider discussing deprescribing with older adults and caregivers in their regular clinical practice, especially when polypharmacy is present. Further research is needed into how to engage older adults and caregivers in shared decision making based on their attitudes toward deprescribing.
Collapse
Affiliation(s)
- Chong-Han Kua
- Pharmaceutical Society of Singapore (PSS) Deprescribing Workgroup, Singapore
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Emily Reeve
- Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Doreen S Y Tan
- Pharmaceutical Society of Singapore (PSS) Deprescribing Workgroup, Singapore
- Khoo Teck Puat Hospital, Singapore
| | - Tsingyi Koh
- Pharmaceutical Society of Singapore (PSS) Deprescribing Workgroup, Singapore
- National University Hospital, Singapore
| | - Jie Lin Soong
- Pharmaceutical Society of Singapore (PSS) Deprescribing Workgroup, Singapore
- Singapore General Hospital, Singapore
| | - Marvin J L Sim
- Pharmaceutical Society of Singapore (PSS) Deprescribing Workgroup, Singapore
- National Healthcare Group Pharmacy, Singapore
| | - Tracy Y Zhang
- Pharmaceutical Society of Singapore (PSS) Deprescribing Workgroup, Singapore
- Ang Mo Kio-Thye Hua Kwan Hospital, Singapore
| | - Yi Rong Chen
- Pharmaceutical Society of Singapore (PSS) Deprescribing Workgroup, Singapore
- Tan Tock Seng Hospital, Singapore
| | - Vanassa Ratnasingam
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Vivienne S L Mak
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- School of Pharmacy, Taylor’s University Lakeside Campus, Subang Jaya, Selangor, Malaysia
| | | |
Collapse
|
41
|
Tsuda S, Nakamura M, Miyachi J, Matsui Y, Takagi M, Ohashi H, Aoki S, Ono H, Ojima T. Decisional Conflict in Home Medical Care in a Family-Oriented Society: Family Members' Perspectives on Surrogate Decision Making from a Multicenter Cohort Study. J Palliat Med 2019; 22:814-822. [DOI: 10.1089/jpm.2018.0493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shuji Tsuda
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Junichiro Miyachi
- The Hokkaido Centre for Family Medicine, Sapporo, Japan
- Center for Medical Education, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
42
|
Jull J, Hizaka A, Sheppard AJ, Kewayosh A, Doering P, MacLeod L, Joudain G, Plourde J, Dorschner D, Rand M, Habash M, Graham ID. An integrated knowledge translation approach to develop a shared decision-making strategy for use by Inuit in cancer care: a qualitative study. Curr Oncol 2019; 26:192-204. [PMID: 31285666 PMCID: PMC6588049 DOI: 10.3747/co.26.4729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In relation to the general Canadian population, Inuit face increased cancer risks and barriers to health services use. In shared decision-making (sdm), health care providers and patients make health care decisions together. Enhanced participation in cancer care decisions is a need for Inuit. Integrated knowledge translation (kt) supports the development of research evidence that is likely to be patient-centred and applied in practice. Objective Using an integrated kt approach, we set out to promote the use of sdm by Inuit in cancer care. Methods An integrated kt study involving researchers with a Steering Committee of cancer care system partners who support Inuit in cancer care ("the team") consisted of 2 theory-driven phases:■ using consensus-building methods to tailor a previously developed sdm strategy and developing training in the sdm strategy; and■ training community support workers (csws) in the sdm strategy and testing the sdm strategy with community members. Results The team developed a sdm strategy that included a workshop and a booklet with 6 questions for use by csws with patients. The sdm strategy (training and booklet) was finalized based on feedback from 5 urban-based Inuit csws who were recruited and trained in using the strategy. Trained csws were matched with 8 community members, and use of the sdm strategy was assessed during interviews, reported as 6 themes. Participants found the sdm strategy to be useful and feasible for use. Conclusions An integrated kt approach of structured research processes with partners developed a sdm strategy for use by Inuit in cancer care. Further work is needed to test the sdm strategy.
Collapse
Affiliation(s)
- J Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A Hizaka
- Tungasuvvingat Inuit, Ottawa, ON
| | - A J Sheppard
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - A Kewayosh
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | | | | | - G Joudain
- Ottawa Health Services Network Inc., Ottawa, ON
| | - J Plourde
- Ottawa Health Services Network Inc., Ottawa, ON
| | - D Dorschner
- Ottawa Health Services Network Inc., Ottawa, ON
| | - M Rand
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - M Habash
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - I D Graham
- Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| |
Collapse
|
43
|
|
44
|
Al Qadire M. Disclosure of Cancer Diagnosis: an Individualized and Non-paternalistic Approach Is Preferred. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:996-1001. [PMID: 28238031 DOI: 10.1007/s13187-017-1192-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is no consensus among healthcare providers on a unified disclosure practice with regard to cancer diagnosis, whether to tell or not. This issue is complicated by the absence of a clear policy for healthcare practitioners, who face this dilemma every day in their clinical practice. This study uniquely aims to explore Jordanian public preference on cancer diagnosis disclosure and the type of information they need. A descriptive cross-sectional survey design was used in this study. The sample consisted of 485 participants who were conveniently selected from the Jordanian public, and data was collected using the Arabic-Cancer Patients Information Needs Questionnaire. The majority of participants were females (56.1%) and most of them (62.1%) were aged between 18 and 29 years. It was found that 421 (86.8%) participants wanted to be informed of the diagnosis if they developed cancer. Participants show high needs of information with mean of total score of 4.2 SD 0.7 out of 5. They mainly demanded to know the things that participants could do to help their cure (mean = 4.47, SD 0.77). Also, they wanted to know whether their cancer was under control or not (item no. 4, mean = 4.42, SD 0.81). This study marks a point of change in public thinking about health issues. Jordanian public preferred to be fully informed of their cancer diagnosis. They wanted information about their prognosis, treatment and the available supportive services, which are of great interest to the Jordanian public.
Collapse
Affiliation(s)
- Mohammad Al Qadire
- Adult Healthcare Nursing Department, Princess Salma Faculty of Nursing, Al Al-Bayt University, P.O.Box 130040, Mafraq, 25113, Jordan.
| |
Collapse
|
45
|
Akechi T. Psycho-oncology: History, Current Status, and Future Directions in Japan. JMA J 2018; 1:22-29. [PMID: 33748519 PMCID: PMC7969909 DOI: 10.31662/jmaj.2018-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/11/2018] [Indexed: 11/11/2022] Open
Abstract
One of the most relevant risk factors for cancer is aging; thus, the number of patients who develop cancer and die is increasing in Japan. Cancer has been a leading cause of death since 1981, and more than one-fourth of Japanese people die of cancer. More than 1,000,000 and 37,000 Japanese people develop cancer and die every year, respectively, making it a major health problem in Japan. Psycho-oncology is a relatively new medical field that was established in the 1970s in Western countries and introduced in Japan in the 1980s. Psycho-oncology was developed for investigating two issues neglected in previous medical research: the impact of behavioral and psychosocial factors on cancer morbidity and mortality and the psychological influence of cancer on patients, their families, and medical staff. Because of progress made in cancer treatment, cancer diagnosis is not necessarily equivalent to a death sentence. However, approximately half of patients with cancer die, and many patients with cancer and their families need appropriate care for psychological distress. The most common psychiatric problems patients with cancer experience are adjustment disorders, major depression, and/or delirium. In addition, the suicide rate in Japan for individuals within 1 year of a cancer diagnosis is more than 20 times higher than that for individuals without cancer. Physical symptoms, such as pain and nausea/vomiting, can be closely associated with psychological function. Mental health professionals, particularly psycho-oncologists, are expected to work with other cancer professionals to manage patients' distress. The present review focuses on patients with cancer' psychological distress and physical symptoms that are closely associated with psychological function and provides an overview of the current status of psycho-oncology in Japan. The future perspective of psycho-oncology is also discussed.
Collapse
Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Psycho-oncology and Palliative Medicine, Nagoya City University Hospital, Nagoya, Japan
| |
Collapse
|
46
|
Nakamura K, Kinugasa Y, Sugihara S, Hirai M, Yanagihara K, Haruki N, Matsubara K, Kato M, Yamamoto K. Sex differences in surrogate decision-maker preferences for life-sustaining treatments of Japanese patients with heart failure. ESC Heart Fail 2018; 5:1165-1172. [PMID: 30264449 PMCID: PMC6300817 DOI: 10.1002/ehf2.12352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022] Open
Abstract
AIMS Patients with end-stage heart failure (HF) often require surrogate decision making for end-of-life care owing to a lack of decision-making capacity. However, the clinical characteristics of surrogate decision making for life-sustaining treatments in Japan remain to be investigated. METHODS AND RESULTS Among 934 patients admitted to our hospital for HF from January 2004 to December 2015, we retrospectively reviewed the medical records of consecutive 106 patients who died in hospital (mean age 73 ± 13 years; male, 52.6%). During hospitalization, attending physicians conducted an average of 2.1 ± 1.4 end-of-life conversations with patients and/or their families. Only 4.7% of patients participated in the conversations and declared their preferences; surrogates made medical care decisions in 95.3% of cases. Most decisions by surrogates (98.1%) were made without the patient's advance directive. During initial end-of-life conversations, 49.4% of surrogates requested cardiopulmonary resuscitation (CPR). However, 72.0% of CPR preferences were changed to do not attempt resuscitation (DNAR) orders in the final conversation. Female surrogates were more likely to change the preference from CPR to DNAR than were male surrogates (47.1% vs. 25.0%, P = 0.023). CONCLUSIONS Compared with male surrogates, female surrogates wavered more often in their decisions regarding life-sustaining treatments of Japanese patients with end-stage HF.
Collapse
Affiliation(s)
- Kensuke Nakamura
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Yoshiharu Kinugasa
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Shinobu Sugihara
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Masayuki Hirai
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Kiyotaka Yanagihara
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Nobuhiko Haruki
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Koichi Matsubara
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Masahiko Kato
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| |
Collapse
|
47
|
What determines the timing of discussions on forgoing anticancer treatment? A national survey of medical oncologists. Support Care Cancer 2018; 27:1375-1382. [DOI: 10.1007/s00520-018-4423-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/13/2018] [Indexed: 11/27/2022]
|
48
|
Malek MM, Abdul Rahman NN, Hasan MS, Haji Abdullah L. Islamic Considerations on the Application of Patient's Autonomy in End-of-Life Decision. JOURNAL OF RELIGION AND HEALTH 2018; 57:1524-1537. [PMID: 29417395 DOI: 10.1007/s10943-018-0575-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In end-of-life situation, the need for patient's preference comes into the picture with the intention of guiding physicians in the direction of patient care. Preference in medical directive is made by a person with full mental capacity outlining what actions should be taken for his health should he loses his competency. This is based on the reality of universal paradigm in medical practice that emphasises patient's autonomy. A specific directive is produced according to a patient's wish that might include some ethically and religiously controversial directives such as mercy killing, physician-assisted suicide, forgoing life-supporting treatments and do-not-resuscitate. In the future, patient autonomy is expected to become prevalent. The extent of patient autonomy has not been widely discussed among Muslim scholars. In Islam, there are certain considerations that must be adhered to.
Collapse
Affiliation(s)
- Mohammad Mustaqim Malek
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- Centre for Science and Environment Studies, Institute of Islamic Understanding Malaysia, No. 2, Langgak Tunku, Off Jalan Tuanku Abdul Halim, 50480, Kuala Lumpur, Malaysia.
| | - Noor Naemah Abdul Rahman
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Luqman Haji Abdullah
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| |
Collapse
|
49
|
Liu Y, Yang J, Huo D, Fan H, Gao Y. Disclosure of cancer diagnosis in China: the incidence, patients' situation, and different preferences between patients and their family members and related influence factors. Cancer Manag Res 2018; 10:2173-2181. [PMID: 30087577 PMCID: PMC6061405 DOI: 10.2147/cmar.s166437] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to investigate the disclosure incidence of cancer diagnosis to patients before chemotherapy, to survey the attitudes of the patients and their families and related influencing factors toward disclosure of cancer diagnosis, and to compare the anxiety and depression levels between the disclosure and non-disclosure patients. Participants and methods A prospective cohort study was conducted at a tertiary hospital in China. A consecutive series of patients who had been diagnosed with malignancy by pathology and their family member were included in our study from March 2017 to December 2017. Patients’ situation, preferences, and their family members’ preferences were investigated by a self-designed questionnaire following a semi-structured interview. The Chinese version of HADS for anxiety and depression was used to test the patients’ psychological distress. Binary logistic regression was used to analyze the related influencing factors of patients’ disclosure of their diagnosis. Results A total of 124 pairs of patients and their family members were analyzed. Of the 124 patients, 47 (37.90%) patients knew about their cancer diagnosis and 77 (62.10%) patients did not know about their cancer diagnosis before chemotherapy. There were more patients than family members who wanted the patients to be informed about the diagnosis of terminal illness (91.9% vs 53.2%, P<0.01). Binary logistic regression analysis showed that patients with university education (odds ratio [OR], 15.322; 95% confidence interval [CI], 1.781–131.781; P<0.05), patients having equal or above average annual income (OR, 5.170; 95% CI, 1.842–14.514; P<0.01) were more likely informed about cancer diagnosis before chemotherapy. Higher anxiety level was found in diagnosis non-disclosure group (P<0.05) and no significant difference in depression score between two groups (P>0.05). Conclusion More than half of the patients did not know their exact diagnosis before chemotherapy in China. Educational level and economic status may be influencing factors for the disclosure of cancer diagnosis. Patients and their family members had different preferences toward diagnosis disclosure.
Collapse
Affiliation(s)
- Yuxiu Liu
- Post-Doctoral Station of Clinical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.,Department of Community Nursing, School of Nursing, Weifang Medical University, Weifang, China
| | - Jinhong Yang
- Department of Oncology, Weifang People's Hospital, Weifang, China
| | - Da Huo
- Department of Oncology, Weifang People's Hospital, Weifang, China
| | - Honghua Fan
- Department of Oncology, Weifang People's Hospital, Weifang, China
| | - Yufang Gao
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China,
| |
Collapse
|
50
|
Park KO, Park SH, Yu M. Physicians' Experience of Communication with Nurses related to Patient Safety: A Phenomenological Study Using the Colaizzi Method. Asian Nurs Res (Korean Soc Nurs Sci) 2018; 12:166-174. [PMID: 29885878 DOI: 10.1016/j.anr.2018.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study attempted to understand the core experiences of physicians related to communicating with nurses in Korea. METHODS Ten physicians who worked at four tertiary university hospitals were interviewed. Data were analyzed using the phenomenological method developed by Colaizzi. RESULTS The following six categories of participants' experience of communication with nurses were extracted from the analysis: (a) "Complex situations and heavy roles that cannot afford safety," (b) "Forcing a superior position in an authoritative environment," (c) "Different perspectives on patient care and difficulties in establishing relationships," (d) "Communicating key clues and receiving feedback from each other," (e) "Apathetic agreements rather than improvements," and (f) "Gradually developing mutually complementary communication." CONCLUSION The present findings revealed that physicians lacked an understanding about the roles and tasks of nurses. The participants engaged in mutually complementary communication with experienced nurses, obtaining desirable patient outcomes and perceived order filtering by nurses as a safety mechanism. It is important for managers to act as proactive change agents to improve communication. Furthermore, the importance and different forms of complementary communication between physicians and nurses need to be described and taught in depth with practical cases.
Collapse
Affiliation(s)
- Kwang-Ok Park
- Department of Nursing, College of Life Science and Natural Resources, Sunchon National University, Sunchon, Republic of Korea
| | - Sung-Hee Park
- Department of Nursing, Kyungmin University, Uijeongbu, Republic of Korea
| | - Mi Yu
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.
| |
Collapse
|