Association Between Person-Centered Care Quality and Advance Care Planning Participation in Patients Undergoing Hemodialysis: A Multicenter Cross-Sectional Study

Abstract

Rationale & ObjectivePerson-centered care (PCC), which incorporates patients’ preferences and values not only for medical care but also for their life, in decision making has been proposed for promoting advance care planning (ACP) among patients with kidney failure.However, how variations in PCC affect ACP participation remain unclear. Therefore, we examined variations in PCC across facilities and examined the association between PCC and ACP participation.Study DesignMulticenter cross-sectional study.Setting & ParticipantsJapanese adults receiving outpatient hemodialysis at six dialysis centers.ExposuresPCC was measured using the 13-item Japanese version of the Primary Care Assessment Tool-short form.OutcomeACP participation as defined by discussion with the attending physician or written documentation or notes regarding treatment preferences.Analytical ApproachA general linear model was used to examine the correlates of the quality of PCC. Modified Poisson regression models were used to examine the associations of ACP participation.ResultsA total of 453 individuals were analyzed; 26.3% participated in ACP. Compared to respondents with no usual source of care (USC), higher PCC was associated with greater ACP participation in a dose-response manner (vs. no USC, adjusted prevalence ratios for the first to fourth quartiles: 1.36, 2.31, 2.64, and 3.10, respectively). Among the PCC sub-domains, first contact, longitudinality, comprehensiveness (services provided), and community orientation were particularly associated with ACP participation. There was a maximum of 12.0 points of facility variation in the quality of PCC.LimitationsPossible reverse causation and unmeasured confounders.ConclusionsHigh PCC quality was associated with ACP participation. The substantial disparity in PCC between facilities provides an opportunity to revisit the quality improvement in PCC.