Sex differences in surrogate decision‐maker preferences for life‐sustaining treatments of <scp>Japanese</scp> patients with heart failure

Nakamura, Kensuke; Kinugasa, Yoshiharu; Sugihara, Shinobu; Hirai, Masayuki; Yanagihara, Kiyotaka; Haruki, Nobuhiko; Matsubara, Koichi; Kato, Masahiko; Yamamoto, Kazuhide

doi:10.1002/ehf2.12352

Cited by 17 publications

(17 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both HFpEF and HFrEF patients can have multiple comorbidities that can affect their treatments and their clinical course, 52 although the extent of this between the two patterns of HF is controversial 53 . The older HF patients’ needs are not only just for mortality reducing therapies but also for quality of life enhancement, well-designed end-of-life care and the involvement of their carers in decision making thought-out the disease process 54 …”

Section: The Effects Of Comorbiditiesmentioning

confidence: 99%

Ageing, demographics, and heart failure

Coats

2019

European Heart Journal Supplements

View full text Add to dashboard Cite

Heart failure (HF) is a complex clinical syndrome resulting from structural or functional cardiac disorders. In the developed world, HF is primarily a disorder of the elderly. It is one that is accompanied by many non-cardiac comorbidities that affect treatments given, the patient’s response and treatment tolerance and outcomes. Even the pathophysiological mechanisms of HF change as we look at older patient populations. Younger HF patients typically have ischaemic heart disease and HF with reduced ejection fraction (HFrEF), whereas older patients have more hypertension HF with preserved ejection fraction (HFpEF). The prevalence of HF has progressively increased for many years and rises even more steeply with age. The outcomes of older especially HFpEF patients have not progressed as much younger HFrEF cohorts. We need more studies specifically recruiting older HF patients with more comorbidities, to guide real-world practice, and we need more assessment of patient-reported outcomes and quality of life rather than just mortality effects. The management of elderly patients with HF requires a more holistic approach recognizing individual needs and necessary support mechanisms and our future trials need to guide us more in achieving these gains.

show abstract

Section: The Effects Of Comorbiditiesmentioning

confidence: 99%

Ageing, demographics, and heart failure

Coats

2019

European Heart Journal Supplements

View full text Add to dashboard Cite

show abstract

“…First, the rate of patients' participation increases as the time of the survey becomes more recent. [10][11][12][13] The rise in the participation rate probably re ects the growing interest in ACP.…”

Section: Discussionmentioning

confidence: 99%

“…in palliative care units). [7][8][9][10][11][12][13] Also, factors that associate with patient involvement in such discussions have yet been clear.…”

Section: Introductionmentioning

confidence: 99%

Patient Participation and Associated Factors in the Discussions on Do-Not-Attempt-Resuscitation and End-of-Life Disclosure: A Retrospective Chart Review Study

Abe

Kobayashi

Kohno

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundPatient participation is a key foundation for advance care planning (ACP). However, a patient himself/herself may be left out from sensitive conversations such as end-of-life (EOL) care discussions. The objectives of this study were to investigate patients’ participation rate in the discussion of Cardiopulmonary Resuscitation (CPR) / Do-Not-Attempt-Resuscitation (DNAR) order, and in the discussion that the patient is at his/her EOL stage (EOL disclosure), and explore their associated factors.MethodsThis is a retrospective chart review study. The participants were all the patients who were hospitalized and died in a university-affiliated teaching hospital (tertiary medical facility) in central Tokyo, Japan during the period from April 2018 to March 2019. The following patients were excluded: (1) cardiopulmonary arrest on arrival (CPAOA); (2) stillbirth; (3) under 18 years old at the time of death; and (4) refusal by their bereaved family. Presence or absence of CPR/DNAR discussion and EOL disclosure, patients’ involvement in those discussions, and their related factors were investigated.ResultsCPR/DNAR discussion was observed in 336 out of the 359 patients (93.6%). The patient participation rate was 33.3% (n= 112). Male gender (odds ratio (OR) = 2.37 [95% confident interval (CI) 1.32-4.25]), living alone (OR = 2.51 [1.34 - 4.71]) and one year or more from diagnosis (OR = 1.78 [1.03 - 3.10]) were associated with patient’s participation in CPR/DNAR discussion. EOL disclosure was observed in 341 out of the 359 patients (95.0%). Half of the patients (n=171; 50.1%) participated in the discussion. Patients who died of cancer (OR = 2.41[1.45-4.03]) and patients without mental illness (OR=2.41 [1.11-5.25]) were more likely to participate in EOL disclosure.ConclusionsIn this clinical sample, only up to half of the patients participated in CPR/DNAR discussion and EoL disclosure. Further attempts to facilitate patients' participation, based on their preference, are warranted. A few sociodemographic, psychosocial, and medical factors that relate to patients’ participation in the discussion on CPR/DNAR and EOL disclosure were demonstrated.

show abstract

“…Under traditional Japanese culture, patients’ self-determination is sometimes in subordination to the will of the family; the Act on Organ Transplantation in Japan prohibits using organs of patients whose family members refused to offer, even when the patient themselves have a will to donate and have a donor card. As well, a previous study reported that among 934 patients with end-stage heart failure, only 4.7% of patients participated in end-of-life conversations with attending physicians and declared their preferences; surrogates made medical care decisions in 95.3% of cases [11].…”

Section: Discussionmentioning

confidence: 99%

Physician Decision-Making Patterns and Family Presence: Cross-Sectional Online Survey Study in Japan

Tsuda¹,

Higuchi²,

Yokoyama³

et al. 2019

Interact J Med Res

View full text Add to dashboard Cite

Background Due to a low birth rate and an aging population, Japan faces an increase in the number of elderly people without children living in single households. These elderly without a spouse and/or children encounter a lack of caregivers because most sources of care for the elderly in Japan are not provided by private agencies but by family members. However, family caregivers not only help with daily living but are also key participants in treatment decision making. The effect of family absence on treatment decision making has not been elucidated, although more elderly people will not have family members to make surrogate decisions on their behalf. Objective The aim is to understand the influence of family absence on treatment decision making by physicians through a cross-sectional online survey with three hypothetical vignettes of patients. Methods We conducted a cross-sectional online survey among Japanese physicians using three hypothetical vignettes. The first vignette was about a 65-year-old man with alcoholic liver cirrhosis and the second was about a 78-year-old woman with dementia, both of whom developed pneumonia with consciousness disturbance. The third vignette was about a 70-year-old woman with necrosis of her lower limb. Participants were randomly assigned to either of the two versions of the questionnaires—with family or without family—but methods were identical otherwise. Participants chose yes or no responses to questions about whether they would perform the presented medical procedures. Results Among 1112 physicians, 454 (40.8%) completed the survey; there were no significant differences in the baseline characteristics between groups. Significantly fewer physicians had a willingness to perform dialysis (odds ratio [OR] 0.55, 95% CI 0.34-0.80; P=.002) and artificial ventilation (OR 0.51, 95% CI 0.35-0.75; P<.001) for a patient from vignette 1 without family. In vignette 2, fewer physicians were willing to perform artificial ventilation (OR 0.59, 95% CI 0.39-0.90; P=.02). In vignette 3, significantly fewer physicians showed willingness to perform wound treatment (OR 0.51, 95% CI 0.31-0.84; P=.007), surgery (OR 0.35, 95% CI 0.22-0.57; P<.001), blood transfusion (OR 0.45, 95% CI 0.31-0.66; P<.001), vasopressor (OR 0.49, 95% CI 0.34-0.72; P<.001), dialysis (OR 0.38, 95% CI 0.24-0.59; P<.001), artificial ventilation (OR 0.25, 95% CI 0.15-0.40; P<.001), and chest compression (OR 0.29, 95% CI 0.18-0.47; P<.001) for a patient without family. Conclusions Elderly patients may have treatments withheld because of the absence of family, highlighting the potential importance of advance care planning in the era of an aging society with a declining birth rate.

show abstract

Sex differences in surrogate decision‐maker preferences for life‐sustaining treatments of Japanese patients with heart failure

Cited by 17 publications

References 31 publications

Ageing, demographics, and heart failure

Ageing, demographics, and heart failure

Patient Participation and Associated Factors in the Discussions on Do-Not-Attempt-Resuscitation and End-of-Life Disclosure: A Retrospective Chart Review Study

Physician Decision-Making Patterns and Family Presence: Cross-Sectional Online Survey Study in Japan

Contact Info

Product

Resources

About