The Impact of Advance Care Planning on Bereaved Cancer Families, Their Relationships, and Their Views on Life and Death in Japan: Findings from the J-HOPE4 Study.

Abstract

Advance care planning (ACP) improves end-of-life care and communication; however, its long-term effects on bereaved family members remain underexplored. This study aimed to (1) examine how bereaved family members' participation in a deceased cancer patient's ACP influenced their own ACP behavior and (2) explore its impact on their interpersonal relationships and values regarding life and death. A nationwide, cross-sectional, anonymous questionnaire survey was conducted as part of the Japan Hospice and Palliative Evaluation Study 4. Participants were bereaved family members of cancer patients who had received care at designated palliative care units in Japan and had died before January 31, 2018. The survey assessed bereaved individuals' ACP behavior (thinking about, discussing, or documenting preferences), discussion partners, and psychological outcomes. Logistic regression analyses identified factors associated with ACP engagement. Of the 639 questionnaires returned (response rate: 63.5%), 544 valid responses were analyzed. Among respondents, 75% had thought about their own ACP, 42.1% had discussed it, and 7.9% had documented it. Participation in a loved one's ACP was significantly associated with thinking about (odds ratio [OR] = 5.07) and discussing (OR = 2.46) one's own ACP. Conversations were linked to increased trust, emotional understanding, and reduced anxiety. Participation in a loved one's ACP was associated with greater engagement in bereaved individuals' own ACP, along with enhanced interpersonal trust and reflection on life and death. These findings support viewing ACP as a relational and life-oriented process.