Relationship between implementation of systematic advance care planning and the quality of death among nursing home residents: a survey

Abstract

Background: Advance care planning (ACP) is beneficial for the quality of death (QOD). However, the effects of ACP on the QOD may vary across cultures. Objectives: This study aimed to explore the relationship between the 15-step ACP program and the QOD among Japanese nursing home residents. Design: A cross-sectional survey. Methods: A cross-sectional survey was conducted among the family members of 39 nursing home residents who died between April 2017 and March 2019 by distributing the survey questionnaire by post. The survey included questions about the QOD of residents, and responses were evaluated using the Good Death Inventory (GDI) scale. Results: Responses were obtained from 30 of the 39 bereaved families (76.9%). Data were analyzed using hierarchical clustering to determine five groups and conduct multiple comparisons. The following three domains of interest were identified: ‘Dying in a favorite place’, ‘Good relationship with the medical staff’, and ‘Independence’. GDI scores were significantly higher for residents with higher ACP completion rates than for those with lower rates ( p < 0.01). Residents who had taken ACP interviews had significantly higher GDI scores ( p < 0.01) than those who had not taken interviews. Conclusion: Overall, these findings suggest that systematic ACP might be related to the QOD among Japanese nursing home residents in the above mentioned three domains. Limitations of the present study were small sample size, cross-sectional survey design as opposed to a cohort survey design, and multiple biases, including the emotional instability of bereaved family members, the length of stay of the residents, the degree of dementia of the residents, and their tendency to talk about the place of death and to develop good relationships with the medical staff.