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Families' and physicians' predictions of dialysis patients' preferences regarding life-sustaining treatments in Japan.
Am J Kidney Dis 2006; 47(1):122-30AJ

Abstract

BACKGROUND

Substituted judgment traditionally has been used often for patient care in Japan regardless of the patient's competency. It has been believed that patient preferences are understood intuitively by family and caregivers. However, there are no data to support this assumption.

METHODS

A questionnaire survey was administered to 450 dialysis patients in 15 hospitals to determine their preferences for cardiopulmonary resuscitation (CPR) and dialysis therapy under various circumstances. Simultaneously, we asked family members and physicians of these patients about patient preferences to evaluate their ability to predict what their patients would want. The accuracy of families' and physicians' judgments was assessed by means of kappa coefficient.

RESULTS

Three hundred ninety-eight pairs, consisting of a patient, 1 of his or her family members, and the physician in charge, participated from 15 hospitals in Japan, with a response rate of 88%. Sixty-eight percent of family members correctly predicted patients' current preferences for CPR, 67% predicted patients' preferences for dialysis when they were severely demented, and 69% predicted patients' preferences for dialysis when they had terminal cancer. Corresponding figures for physicians were 60%, 68%, and 66%. When using kappa coefficient analysis, those results indicated that neither family members nor physicians more accurately predicted their patients' wishes about life-sustaining treatments than expected by chance alone. (All kappa coefficients <0.4.)

CONCLUSION

Our study suggests that patients who want to spend their end-of-life period as they want should leave better advance directives.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan. yamiura-circ@umin.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16377393

Citation

Miura, Yasuhiko, et al. "Families' and Physicians' Predictions of Dialysis Patients' Preferences Regarding Life-sustaining Treatments in Japan." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 47, no. 1, 2006, pp. 122-30.
Miura Y, Asai A, Matsushima M, et al. Families' and physicians' predictions of dialysis patients' preferences regarding life-sustaining treatments in Japan. Am J Kidney Dis. 2006;47(1):122-30.
Miura, Y., Asai, A., Matsushima, M., Nagata, S., Onishi, M., Shimbo, T., ... Fukuhara, S. (2006). Families' and physicians' predictions of dialysis patients' preferences regarding life-sustaining treatments in Japan. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 47(1), pp. 122-30.
Miura Y, et al. Families' and Physicians' Predictions of Dialysis Patients' Preferences Regarding Life-sustaining Treatments in Japan. Am J Kidney Dis. 2006;47(1):122-30. PubMed PMID: 16377393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Families' and physicians' predictions of dialysis patients' preferences regarding life-sustaining treatments in Japan. AU - Miura,Yasuhiko, AU - Asai,Atsushi, AU - Matsushima,Masato, AU - Nagata,Shizuko, AU - Onishi,Motoki, AU - Shimbo,Takuro, AU - Hosoya,Tatsuo, AU - Fukuhara,Shunichi, PY - 2005/04/07/received PY - 2005/09/27/accepted PY - 2005/12/27/pubmed PY - 2006/2/10/medline PY - 2005/12/27/entrez KW - Death and Euthanasia KW - Empirical Approach SP - 122 EP - 30 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 47 IS - 1 N2 - BACKGROUND: Substituted judgment traditionally has been used often for patient care in Japan regardless of the patient's competency. It has been believed that patient preferences are understood intuitively by family and caregivers. However, there are no data to support this assumption. METHODS: A questionnaire survey was administered to 450 dialysis patients in 15 hospitals to determine their preferences for cardiopulmonary resuscitation (CPR) and dialysis therapy under various circumstances. Simultaneously, we asked family members and physicians of these patients about patient preferences to evaluate their ability to predict what their patients would want. The accuracy of families' and physicians' judgments was assessed by means of kappa coefficient. RESULTS: Three hundred ninety-eight pairs, consisting of a patient, 1 of his or her family members, and the physician in charge, participated from 15 hospitals in Japan, with a response rate of 88%. Sixty-eight percent of family members correctly predicted patients' current preferences for CPR, 67% predicted patients' preferences for dialysis when they were severely demented, and 69% predicted patients' preferences for dialysis when they had terminal cancer. Corresponding figures for physicians were 60%, 68%, and 66%. When using kappa coefficient analysis, those results indicated that neither family members nor physicians more accurately predicted their patients' wishes about life-sustaining treatments than expected by chance alone. (All kappa coefficients <0.4.) CONCLUSION: Our study suggests that patients who want to spend their end-of-life period as they want should leave better advance directives. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16377393/Families'_and_physicians'_predictions_of_dialysis_patients'_preferences_regarding_life_sustaining_treatments_in_Japan_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(05)01516-7 DB - PRIME DP - Unbound Medicine ER -