• Jun Miyashita, Ayako Kohno, Shao-Yi Cheng, Su-Hsuan Hsu, Yosuke Yamamoto, Sayaka Shimizu, Wei-Sheng Huang, Motohiro Kashiwazaki, Noriki Kamihiro, Kaoru Okawa, Masami Fujisaki, Jaw-Shiun Tsai, and Shunichi Fukuhara.
• Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.
• Palliat Med. 2020 Jul 1; 34 (7): 906-916.

BackgroundAlthough advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain.AimTo evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan.DesignMixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing.Setting/ParticipantsPatients aged 40-75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited.ResultsOverall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan (p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers' initiative.ConclusionThe majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients' preferences and factors associated with acceptance and reluctance to initiate advance care planning.

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