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Association between person-centred care quality and advance care planning participation in haemodialysis
  1. Yusuke Kanakubo1,2,
  2. Noriaki Kurita3,4,
  3. Mamiko Ukai1,
  4. Tetsuro Aita3,5,
  5. Ryohei Inanaga3,6,
  6. Atsuro Kawaji7,
  7. Takumi Toishi7,
  8. Masatoshi Matsunami3,7,
  9. Yu Munakata8,9,
  10. Tomo Suzuki3,7 and
  11. Tadao Okada1
  1. 1Tessyoukai Kameda Family Clinic Tateyama, Tateyama-city, Chiba, Japan
  2. 2Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
  3. 3Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima-city, Fukushima, Japan
  4. 4Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima-city, Fukushima, Japan
  5. 5Department of General Internal Medicine, Fukushima Medical University Hospital, Fukushima-city, Fukushima, Japan
  6. 6Department of Nephrology, Shin-Yurigaoka General Hospital, Kawasaki-city, Kanagawa, Japan
  7. 7Department of Nephrology, Kameda Medical Center, Kamogawa-city, Chiba, Japan
  8. 8Munakata Clinic, Mobara-city, Chiba, Japan
  9. 9Chikuseikai Munakata Clinic, Shinjuku-ku, Tokyo, Japan
  1. Correspondence to Professor Noriaki Kurita, Department of Clinical Epidemiology, Fukushima Medical University, Fukushima 960-1295, Japan; kuritanoriaki{at}


Objective Person-centred care (PCC), which incorporates patients’ preferences and values for medical care and their life, has been proposed in decision-making for promoting advance care planning (ACP) among patients with kidney failure. Therefore, we aimed to examine variations in PCC across facilities and the association between PCC and ACP participation.

Methods This multicentre cross-sectional study included Japanese adults undergoing outpatient haemodialysis at six dialysis centres. The main exposure was PCC, measured using the 13-item Japanese version of the Primary Care Assessment Tool-short form. The main outcome was ACP participation as defined by discussion with the attending physician or written documentation or notes regarding treatment preferences. A general linear model was used to examine the covariates of the quality of PCC. Modified Poisson regression models were used to examine the associations of ACP participation.

Results A total of 453 individuals were analysed; 26.3% of them participated in ACP. Higher PCC was associated with greater ACP participation in a dose–response manner (adjusted prevalence ratios for the first to fourth quartiles: 1.36, 2.31, 2.64 and 3.10, respectively) in respondents with usual source of care (USC) than in those without USC. Among the PCC subdomains, first contact, longitudinality, comprehensiveness (services provided) and community orientation were particularly associated with ACP participation. A maximum of 12.0 points of facility variation was noted in the quality of PCC.

Conclusions High quality of PCC was associated with ACP participation. The substantial disparity in PCC between facilities provides an opportunity to revisit the quality improvement in PCC.

  • Advance Care Planning
  • Renal failure

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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  • Contributors Research idea and study design: YK, NK and TO; data acquisition: YK, MU, RI, AK, TT, MM, YM and TS; data analysis/interpretation: YK, NK and TA; statistical analysis: YK and NK; supervision or mentorship: NK and TO. Each author contributed important intellectual content during manuscript drafting or revision, agreed to be personally accountable for the individual’s own contributions, and ensured that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, were appropriately investigated, and resolved, including documentation in the literature, if appropriate. NK acts as the the guarantor who accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This study was supported by JSPS KAKENHI (grant numbers: JP19KT0021).

  • Competing interests NK received grants from the Japan Society for the Promotion of Science, consulting fees from GlaxoSmithKline K.K., and payments for speaking and educational events from Taisho Pharmaceutical and Eisai. RI received payments for speaking from Astellas Pharma, Novartis Pharma K.K., and Otsuka Pharmaceuticals. TT received payment for speaking and educational events from Otsuka Pharmaceuticals. MM received payments for speaking and educational events from Astellas Pharma and Baxter. TS has received payment for speaking and educational events from Astellas Pharma, AstraZeneca K.K, Baxter, Bayer Yakuhin, Bristol-Myers Squibb Co., CureApp, Chugai Pharmaceutical, Daiichi Sankyo, Eli Lilly Japan K.K., Janssen Pharmaceutical K.K, Kaneka Medix, Kissei Pharmaceutical, Kowa, Kyowa Kirin, Mochida Pharmaceutical, Nobelpharma, Novartis Pharma K.K., Novo Nordisk Pharm, Ono Pharmaceutical, Otsuka Pharmaceutical, Terumo and Torii Pharmaceutical.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.