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Documentation of nursing home residents' preferences regarding end-of-life care in Japan: Does the documentation serve as an advanced directive in care planning?
Abstract
Rationale, aims and objective: In 2006, the public long-term care insurance system in Japan introduced a documentation of a nursing home resident’s preferences regarding end-of-life care. However, it is unclear whether the documentation of preferences serves as an advanced directive in care planning. The aim was to examine the association between documentation of a nursing home resident’s preferences regarding end-of-life care and (1) preferences on place of death, (2) comfort at end-of-life in facilities and (3) death of residents in hospitals.
Methods: A retrospective study design was used to collect data regarding decedents in long-term care facilities across 3 prefectures in Japan in August 2014. A total of 211 decedents from 62 facilities were included in the analysis. The Managing Director provided information on each resident’s and relative’s preferred place of death, comfort during the last 7 days of life in the facility and actual place of death. The Comfort around Dying End-of-Life in Dementia scale (CAD-EOLD) was used to assess comfort.
Results: Residents’ preferences regarding place of death was unable to be determined regardless of completion of routine documentation. Relatives of residents in facilities that completed routine documentation were more likely to prefer that death occurred at the facility. The comfort and likelihood of hospital death did not vary according to the completion of routine documentation.
Conclusion: Routine documentation may have confirmed the preferences of relatives instead of residents themselves. Communication strategies should be established as part of the documentation of nursing home resident’s preferences to ensure quality of end-of-life care in accordance with the resident’s preferences.
Keywords
References
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DOI: http://dx.doi.org/10.5750/ejpch.v3i3.982
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