Family Physicians' Perspectives and Practices on Advance Care Planning in Regional Cities in Japan and the United States: A Convergent Parallel Mixed-Methods Study

Abstract

Background: Advance care planning (ACP) has been widely recognized and practiced worldwide since the 1990s. However, only a few studies have compared clinicians' international perceptions of and experiences with ACP. Therefore, this study explored the perceptions and practices of family physicians (FPs) regarding ACP in Japan and the United States.

Methods: We conducted a convergent parallel mixed-methods study using a cross-sectional web-based anonymous questionnaire survey to examine how the perceptions and practices of ACP differ between Japanese and American FPs working in regional cities.

Results: Responses from 20 and 19 FPs in Japan and the United States were obtained, respectively. Both FP groups received ACP training during their residency and practiced ACP with the highest regard for the patient's wishes and values. Quantitative analysis revealed that American FPs placed more emphasis on documentation and patient language skills. Qualitative analysis revealed that Japanese FPs equally emphasized communication with patients' families and with patients. We merged the results of both analyses and hypothesized that the variations in the FPs' approaches to ACP might reflect variations in their backgrounds, such as health insurance systems, cultures, and values in the two countries, rather than differences between individual physicians.

Conclusion: Our study showed that both Japanese and American FPs respect patients' wishes in ACP, with some differences in their perceptions and practices. Therefore, FPs should understand and be flexible with their patients' values and cultural backgrounds as intercultural translators while following appropriate management procedures for successful ACP.

Keywords: advance care planning; convergent parallel mixed method; cross-national research; family medicine; family physician (fp); japan; the united states.

Figure 1. Perceptions of FPs in both countries on the conflict items and our original question

Conflict items were those items in which the Delphi panel did not reach a consensus. P-values are the results of Fisher's exact and Wilcoxon rank-sum tests for the "agree" vs. "disagree" groups. Statistical significance was set at p<0.05 (*) with a two-tailed test AD: advance directives; ACP: advance care planning; FP: family physicians; JPN: Japan; US: United States

Figure 2. Elements of patient communication that FPs consider important in implementing

Fisher's exact test and Wilcoxon rank-sum test were used for quantitative analysis to compare the two groups. Statistical significance was set at p<0.05 (*) with a two-tailed test JPN: Japan; US: United States; FP: family physician