title: Survey of the general public's attitudes toward advance directives in Japan: how to respect patients' preferences.
abstract: BACKGROUND
  Japanese people have become increasingly interested in the expression and enhancement of their individual autonomy in medical decisions made regarding medical treatment at and toward the end of life. However, while many Western countries have implemented legislation that deals with patient autonomy in the case of terminal illness, no such legislation exists in Japan. The rationale for this research is based on the need to investigate patient's preferences regarding treatment at the end of life in order to re-evaluate advance directives policy and practice.
  
  
  METHODS
  We conducted a cross-sectional survey with 418 members of the general middle-aged and senior adults (aged between 40 and 65) in Tokyo, Japan. Respondents were asked about their attitudes toward advance directives, and preferences toward treatment options.
  
  
  RESULTS
  Over 60% of respondents agreed that it is better to express their wishes regarding advance directives (treatment preferences in writing, appointment of proxy for care decision making, appointment of legal administrator of property, stating preferences regarding disposal of one's property and funeral arrangements) but less than 10% of them had already done so. About 60% of respondents in this study preferred to indicate treatment preferences in broad rather than concrete terms. Over 80% would like to decide treatment preferences in consultation with others (22.2% with their proxy, 11.0% with the doctor, and 47.8% with both their proxy and the doctor).
  
  
  CONCLUSIONS
  This study revealed that many Japanese people indicate an interest in undertaking advance directives. This study found that there is a range of preferences regarding how advance directives are undertaken, thus it is important to recognize that any processes put into place should allow flexibility in order to best respect patients' wishes and autonomy.
authors.affiliation: Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Japan. h-m@umin.net.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Hiromi
authors.initials: H
authors.lastname: Shiraishi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kai
mesh_terms: D016223:Advance Directives / Q000523:psychology* / Q000639:trends; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000523:psychology / Q000706:statistics & numerical data; D003128:Coma; D003625:Data Collection; D003704:Dementia; D003956:Dialysis / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008020:Life Support Care / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D018529:Nutritional Support / Q000523:psychology / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D026684:Personal Autonomy; D011379:Prognosis; D019727:Proxy; D011639:Public Opinion; D013997:Time Factors; D016896:Treatment Outcome; D014691:Ventilation / Q000706:statistics & numerical data