Abstract
Background:
Advance care planning (ACP) improves end-of-life care and communication; however, its long-term effects on bereaved family members remain underexplored.
Objectives:
This study aimed to (1) examine how bereaved family members’ participation in a deceased cancer patient’s ACP influenced their own ACP behavior and (2) explore its impact on their interpersonal relationships and values regarding life and death.
Design:
A nationwide, cross-sectional, anonymous questionnaire survey was conducted as part of the Japan Hospice and Palliative Evaluation Study 4.
Setting/Subjects:
Participants were bereaved family members of cancer patients who had received care at designated palliative care units in Japan and had died before January 31, 2018.
Measurements:
The survey assessed bereaved individuals’ ACP behavior (thinking about, discussing, or documenting preferences), discussion partners, and psychological outcomes. Logistic regression analyses identified factors associated with ACP engagement.
Results:
Of the 639 questionnaires returned (response rate: 63.5%), 544 valid responses were analyzed. Among respondents, 75% had thought about their own ACP, 42.1% had discussed it, and 7.9% had documented it. Participation in a loved one’s ACP was significantly associated with thinking about (odds ratio [OR] = 5.07) and discussing (OR = 2.46) one’s own ACP. Conversations were linked to increased trust, emotional understanding, and reduced anxiety.
Conclusions:
Participation in a loved one’s ACP was associated with greater engagement in bereaved individuals’ own ACP, along with enhanced interpersonal trust and reflection on life and death. These findings support viewing ACP as a relational and life-oriented process.
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