Association between resilience and advance care planning during the COVID-19 pandemic in Japan: a nationwide cross-sectional study

(Via Nature.com) Advance care planning (ACP) is a process that facilitates adult understanding and the sharing of personal values, life goals, and preferences in regard to future medical care1,2. Previous studies have reported the effects of patient-centered ACP discussions on the quality of end-of-life care, emotional trauma in families, and the utilization of health-care services3,4,5. Discussions about ACP have been more critical for end-of-life care in aged societies such as Japan, where the aged population is expected to reach 30% by 20256. However, the prevalence of ACP discussions in Japan has been reported to be 35–40%7,8, which is substantially lower than that in the United States (67%)9 and Canada (52%)10. Previous studies have also reported factors specific to Japan that hinder the prevalence of ACP, such as family-centered decision-making11 and high-context culture2, in addition to physicians’ reluctance to engage in ACP12,13.

Discussions about ACP have been considered more essential during the pandemic caused by the novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) disease of 2019 (COVID-19)14,15. During the COVID-19 pandemic, there have been places around the world where scarce life-sustaining treatments could not be provided to all patients in need. In such situations, “rationing” decisions had to be made, which were incredibly challenging to all health-care providers and patients involved16. ACP discussions could reduce the need to ration limited life-sustaining treatments by identifying patients who would not want to receive them if affected by severe COVID-19 pneumonia14. However, ACP discussions should not be used as triage allocation decisions, but rather, as processes where adults develop individualized care plans14,15. In addition, the medical conditions of patients with COVID-19 might suddenly deteriorate. Therefore, it is important for adults of any age or with any health condition to discuss ACP ahead of the possibility of health deterioration and before facing a health crisis to ensure that their personal values, life goals, and preferences for medical and long-term care are known14,15. Therefore, especially during the COVID-19 pandemic, meaningful ACP discussions should be required at an appropriate time. Continue…