Relationship between patient-centred care and advance care planning among home medical care patients in Japan: the Zaitaku evaluative initiatives and outcome study.

Abstract

There is a growing need to realize high-quality end-of-life care at home that respects the patient's wishes. To examine the association between the quality of primary care and advance care planning (ACP) participation among patients receiving home-based medical care. In this multicentre, cross-sectional study, 29 home medical care clinics in Japan were included. Adult Japanese patients receiving home medical care were surveyed to assess their consideration of ACP. The quality of primary care, which reflects patient-centredness, was assessed with the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF). Information on the clinical conditions that require home medical care was collected from physicians. Of the 194 patients surveyed from 29 home medical services, 62 patients (32%) showed signs of ACP participation. Lack of opportunities was the most common reason for not participating in the ACP. In a multivariable-adjusted generalized estimating equation, primary care quality was associated with ACP participation (per 10-point increase, adjusted odds ratio: 1.96, 95% confidence interval: 1.51-2.56). In addition, all domains of the JPCAT-SF were associated with ACP participation. Patient-centredness in home medical care facilitates the initiation of ACP participation.