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

• Material Type: 博士論文
• ISSN: 1096-6218
• Title: Impact of patients’ expressed wishes on their surrogate decision makers’ preferred decision-making roles in Japan
• Volume: 21 3
• Author/Editor: 津田, 修治
• Author Heading: 津田, 修治
• Publication, Distribution, etc.: Mary Ann Liebert
• Publication Date: 2018-03-01
• Publication Date (W3CDTF): 2018-03-01
• Alternative Title: 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
• Periodical title: Journal of Palliative Medicine
• Degree grantor/type: 浜松医科大学
• Date Granted: 2018-03-13
• Date Granted (W3CDTF): 2018-03-13
• Dissertation Number: 甲第786号
• Degree Type: 博士（医学）
• Conferring No. (Dissertation): 甲第786号
• Text Language Code: eng
• Target Audience: 一般
• Note (General): doctoral; 医学系研究科; 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.
• DOI: info:doi/10.1089/jpm.2017.0226; https://doi.org/info:doi/10.1089/jpm.2017.0226
• Persistent ID (NDL): info:ndljp/pid/11278479; https://dl.ndl.go.jp/pid/11278479
• Collection: 障害者向け資料
• Collection (Materials For Handicapped People:1): テキストデータ
• Collection (particular): 国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文; https://dl.ndl.go.jp/collections/A00014
• Acquisition Basis: 博士論文（自動収集）
• Date Accepted (W3CDTF): 2019-05-06T10:27:56+09:00
• Date Created (W3CDTF): 2019-02-21
• Format (IMT): application/pdf
• Access Restrictions: 国立国会図書館内限定公開
• Service for the Digitized Contents Transmission Service: 図書館・個人送信対象外
• Availability of remote photoduplication service: 可
• Periodical Title (URI): http://hdl.handle.net/10271/00003505; https://hama-med.repo.nii.ac.jp/records/3364
• Data Provider (Database): 国立国会図書館 : 国立国会図書館デジタルコレクション; https://dl.ndl.go.jp

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2023-12-09 再収集