JMIR Publications

ABSTRACT

Background:

Japan faces increase of elderly people without children living in single households with the progress of low birthrate and aging population. The elderly without spouse and/or children result in lack of caregivers because most care for the elderly are not provided by private agencies but by family members in Japan. However, family caregivers are not only helpers of daily living but are key participants in the treatment decision-making. Effect of family absence on treatment decision-making has not been elucidated although more and more elderly people will not have family members who make surrogate decisions on behalf of incapacitated themselves.

Objective:

To understand the influence of family absence on treatment decision-making, we conducted a randomized, cross-sectional online survey with three hypothetical vignettes of patients.

Methods:

We conducted a randomised 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 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 either of the two versions of questionnaires—with family or without family—but otherwise identical. 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 and 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; P=0.002) and artificial ventilation (OR, 0.51; P<0.001) for a patient from vignette one, without family. Similarly, artificial ventilation was less intended in vignette two (OR, 0.59; P=0.02). In vignette three, significantly fewer physicians showed willingness to perform wound treatment (OR, 0.51; P=0.007), surgery (OR, 0.35; P<0.001), blood transfusion (OR, 0.45; P<0.001), vasopressor (OR, 0.49; P<0.001), dialysis (OR, 0.38; P<0.001), artificial ventilation (OR, 0.25; P<0.001) and chest compression (OR, 0.29; P<0.001) for a patient without family.

Conclusions:

Elderly patients may sometimes be submitted to treatments withheld due to the absence of family, highlighting the potential importance of the advance care planning in the era of aging society with declining birthrate. Clinical Trial: None