title: End-of-Life Care and Discussions in Japanese Geriatric Health Service Facilities: A Nationwide Survey of Managing Directors' Viewpoints.
abstract: BACKGROUND
  Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies.
  
  
  OBJECTIVE
  This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan.
  
  
  METHODS
  We conducted a nationwide cross-sectional survey by mailing questionnaires about EOL care and EOLDs to 3437 GHSF managing directors. The questionnaire was developed through a literature review and discussion among the researchers and experts. Descriptive statistics summarized the data. We also analyzed the factors related to GHSFs conducting EOLDs using Fisher exact tests.
  
  
  RESULTS
  The response rate was 20.7% (713 of 3437). Among the respondents, 75.2% (536 of 713) of GHSFs provided EOL care and 73.1% (521 of 713) conducted EOLDs. The most common reasons for difficulties in providing EOL care included the lack of EOL education for nurses and care workers, and their fear about caring for dying residents. End-of-life discussions were mostly initiated after the deterioration of a resident's condition and were conducted with families by physicians. Statistically significant factors of GHSFs conducting EOLDs included providing EOL education for nurses and care workers, availability of private room for critically ill residents, emergency on-call doctors, and EOL care.
  
  
  CONCLUSIONS
  Adequate practical staff education programs for EOL care including EOLDs may be crucial for quality of end-of-life care in aged care facilities.
authors.affiliation: 1 Department of Internal Medicine, Yoshida Hospital, Nara, Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Kanoh
authors.affiliation: 2 Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
authors.affiliation: 3 Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
authors.affiliation: 4 Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Yokoya
mesh_terms: D000288:Administrative Personnel / Q000523:psychology*; D001291:Attitude of Health Personnel; D000075902:Clinical Deterioration; D003430:Cross-Sectional Studies; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training; D007564:Japan; D011368:Professional-Family Relations; D011787:Quality of Health Care / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration*; D013997:Time Factors
keywords: advance care planning; advance directives; aged care; education; elderly; end-of-life care; end-of-life discussions; geriatric health service facilities