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Improving Patient Preparedness and Confidence in Discussing Advance Directives for End-of-Life Care with Health Care Providers in the United States and Japan

Author

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  • John M. Friend
  • Dana L. Alden

Abstract

Background The low completion rate of advance directives (ADs) has received attention in Japan and the United States, as policy makers and health care professionals face aging populations with multiple comorbidities. Among the barriers to AD planning, cultural values and attitudes appear to be particularly influential. A comparison of culturally distinct societies provides a deeper understanding of these barriers. Through such an approach, this study identifies strategies for increasing AD planning among late-middle-age Japanese and US individuals. Methods After giving informed consent for the Institutional Review Board–approved study, Japanese and US respondents (45–65 y; 50% female) without ADs completed a language-appropriate online survey. Participants were asked to review a decision aid as part of a scenario-based physician consultation regarding artificial nutrition and hydration (ANH). Hypotheses were analyzed using multigroup structural equation modeling. Results Important similarities were identified across the 2 groups. After reviewing the decision aid, both samples strongly preferred “no ANH.†Respondents who strongly valued either self-reliance or interpersonal relationships experienced greater preparedness for AD planning. In both countries, greater decision preparedness and positive death attitude predicted greater confidence to discuss care options with a provider. Finally, cultural values predicted preference for family participation: respondents with a strong interdependent self-concept desired more family involvement, whereas high independents preferred less. Conclusions Findings indicate the importance of documenting care preferences and accounting for individual differences. To increase AD adoption, providers should identify patient segments likely to benefit most from the interventions. Targeting individuals in both countries who value self-reliance and interpersonal relationships appears to be a good place to begin. Such individuals can be identified clinically through administration of validated measures used in this study.

Suggested Citation

  • John M. Friend & Dana L. Alden, 2021. "Improving Patient Preparedness and Confidence in Discussing Advance Directives for End-of-Life Care with Health Care Providers in the United States and Japan," Medical Decision Making, , vol. 41(1), pages 60-73, January.
    • Handle: RePEc:sae:medema:v:41:y:2021:i:1:p:60-73
    DOI: 10.1177/0272989X20969683
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    References listed on IDEAS

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    1. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond.
    2. Eric French & Jeremy Mccauley & Maria Aragon & Pieter Bakx & Martin Chalkley & Stacey H. Chen & Bent J. Christensen & Hongwei Chuang & Aurelie Côté-Sergent & Mariacristina de Nardi & Elliott Fan & Dam, 2017. "End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported," Post-Print halshs-01631529, HAL.
    3. Pollack, Keshia M. & Morhaim, Dan & Williams, Michael A., 2010. "The public's perspectives on advance directives: Implications for state legislative and regulatory policy," Health Policy, Elsevier, vol. 96(1), pages 57-63, June.
    4. Sinclair, Craig & Smith, Jessica & Toussaint, Yann & Auret, Kirsten, 2014. "Discussing dying in the diaspora: Attitudes towards advance care planning among first generation Dutch and Italian migrants in rural Australia," Social Science & Medicine, Elsevier, vol. 101(C), pages 86-93.
    5. Alden, Dana L. & Friend, John & Schapira, Marilyn & Stiggelbout, Anne, 2014. "Cultural targeting and tailoring of shared decision making technology: A theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups," Social Science & Medicine, Elsevier, vol. 105(C), pages 1-8.
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