Impact of patients’ expressed wishes on their surrogate decision makers’ preferred decision-making roles in Japan

津田, 修治

doi:https://doi.org/10.1089/jpm.2017.0226

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Impact of patients’ expressed wishes on their surrogate decision makers’ preferred decision-making roles in Japan

http://hdl.handle.net/10271/00003505

名前 / ファイル	ライセンス	アクション
論文本文 (593.0 kB)

Item type

学位論文 / Thesis or Dissertation(1)

公開日

2019-02-21

タイトル

Impact of patients’ expressed wishes on their surrogate decision makers’ preferred decision-making roles in Japan

言語

eng

資源タイプ

資源タイプ識別子

http://purl.org/coar/resource_type/c_db06

資源タイプ

doctoral thesis

アクセス権

open access

アクセス権URI

http://purl.org/coar/access_right/c_abf2

その他のタイトル

日本での、代理意思決定者の意思決定において希望する役割へ、患者の意思表示が与える影響

著者

津田, 修治

書誌情報

en : Journal of Palliative Medicine

巻 21, 号 3, p. 354-360, 発行日 2018-03-01

出版者

Mary Ann Liebert

言語

権利

言語

権利情報

Final publication is available from Mary Ann Liebert,Inc. : http://dx.doi.org/10.1089/jpm.2017.0226

抄録

内容記述タイプ

Abstract

内容記述

Background: Home medical care (HMC) patients and their families are expected to prepare for end-of-life decision making.
Objective: We investigated the decision readiness of HMC patients and their family surrogates.
Design: Cross-sectional survey.
Setting/Subjects: We collected data from dyads consisting of a HMC patient aged 65 years or older and a family member of the patient, recruited at four Japanese primary care clinics from January 2016 to November 2016.
Measurements: Surrogates completed a questionnaire on their sociodemographic and health status and their decision readiness. Primary HMC physicians provided information on their patients.
Results: A total of 337 dyads were screened, and 159 were included. The mean age of patients and surrogates was 86 and 64 years respectively, and 29% of patients were cognitively impaired. Only 1.9% of the patients left written advance directives, and 32% were entrusting all decision-making to the doctor or their families. Regarding the surrogate's preferred decision-making role, 21.9% of the surrogates preferred doctors to assume decision-making responsibility. A multivariate analysis revealed that no discussion of care goals (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.02-8.17) and patients having expressed their wishes verbally, including entrusting decision making to others (OR 2.51, 95% CI 1.07-5.89), were associated with surrogates' preference for doctors to have decision-making responsibility.
Conclusions: Many patients preferred to entrust the end-of-life decisions to others rather than utilizing advance directives, which made surrogates more dependent on doctors for decision making. Qualified advance care planning is required to promote familial discussion and surrogates' decision readiness.

言語

学位名

博士（医学）

学位の区分

内容記述

doctoral

学位の分野

内容記述

医学系研究科

学位授与機関

学位授与機関識別子Scheme

kakenhi

学位授与機関識別子

13802

学位授与機関名

浜松医科大学

学位授与年月日

2018-03-13

学位授与番号

甲第786号

ISSN

収録物識別子タイプ

PISSN

収録物識別子

1096-6218

EISSN

収録物識別子タイプ

EISSN

収録物識別子

1557-7740

PubMed番号

識別子タイプ

PMID

Versions

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2023-06-20 16:41:35.258956

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Impact of patients’ expressed wishes on their surrogate decision makers’ preferred decision-making roles in Japan

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