Association between physicians’ characteristics and their knowledge, attitudes, and practices regarding advance care planning: a cross-sectional study

• Published in: BMC palliative care 2023-09, Vol.22 (1), p.1-134, Article 134
• Main Authors: Sakamoto, Ayaka, Inokuchi, Ryota, Iwagami, Masao, Hanari, Kyoko, Tamiya, Nanako
• Format: Article
• Language: English
• Subjects: Advance care planning; Advance directives; Analysis; Attitudes; Cross-sectional studies; Cross-sectional study; Ethical aspects; Gender; Health surveys; Hospice care; Hospitals; Internal medicine; Japan; Knowledge; Medicine; Methods; Missing data; Palliative care; Physicians; Practice; Questionnaires; Response rates; Sensitivity analysis; Social aspects; Surgery; Surveys; Terminal care; Variables
• ISSN: 1472-684X; 1472-684X
• DOI: 10.1186/s12904-023-01253-x

Background Despite physicians' vital role in advance care planning, a limited number of physicians practice it. This study assessed factors associated with physicians' knowledge, attitudes, and practices regarding advance care planning. Methods This cross-sectional study used data from an anonymous survey conducted by the Japanese Ministry of Health, Labour and Welfare. Questionnaires were mailed to 4500 physicians in November and December 2022. Data from 1260 respondents were analyzed. Results Of the respondents, 46.4%, 77.0%, and 82.0% reported good knowledge of advance care planning, agreed with promoting it, and with its provision by medical/care staff, respectively. Male physicians were significantly less likely to support advance care planning (odds ratio: 0.54, 95% confidence interval: 0.35-0.84) or agree to its provision by medical/care staff (odds ratio: 0.47, 95% confidence interval: 0.29-0.78) but significantly more likely to practice it (odds ratio: 1.58, 95% confidence interval: 1.05-2.36). Physicians specialized in surgery or internal/general/palliative medicine were more knowledgeable about advance care planning and more likely to practice it. Physicians working in clinics were significantly less knowledgeable (odds ratio: 0.33, 95% confidence interval: 0.25-0.44) about advance care planning and less likely to support it (odds ratio: 0.37, 95% confidence interval: 0.27-0.50), agree with its provision by medical/care staff (odds ratio: 0.54, 95% confidence interval: 0.39-0.75), or to practice it (odds ratio: 0.16, 95% confidence interval: 0.12-0.22). Conclusions Physicians working in clinics had less knowledge of advance care planning, less supportive attitudes, and less likely to practice it. Knowledge, attitudes and practice also varied by gender and specialty. Interventions should target physicians working in clinics. Keywords: Advance care planning, Terminal care, Physicians, Japan, Cross-sectional study