title: Families' and physicians' predictions of dialysis patients' preferences regarding life-sustaining treatments in Japan.
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.)
  
  
  CONCLUSIONS
  Our study suggests that patients who want to spend their end-of-life period as they want should leave better advance directives.
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan. yamiura-circ@umin.ac.jp
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Miura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Asai
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.forename: Shizuko
authors.initials: S
authors.lastname: Nagata
authors.forename: Motoki
authors.initials: M
authors.lastname: Onishi
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Hosoya
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D003142:Communication; D003469:Culture; D003704:Dementia / Q000523:psychology; D005190:Family / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006801:Humans; D007564:Japan; D007600:Judgment; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D009398:Nephrology; D017060:Patient Satisfaction; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D006435:Renal Dialysis; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000523:psychology; D020458:Third-Party Consent