Advance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally...Show moreAdvance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally accepted in Western countries and has a positive effect on end-of-life care for people with dementia. However, culture affects expectations and preferences regarding end-of-life care and decision making. This study compared the acceptability of and preference for two types of ACP interventions for patients with dementia in health care providers from the Netherlands, the US and Japan. One intervention focused on concrete treatment orders in which the patient makes specific decisions. The other focused on what the patient finds important in life, resulting in global goals of care. A total of 125 participants were assessed by means of a structured interview and a questionnaire. Participants found both types of ACP acceptable, in general and per country. A multinomial logistic regression analysis indicated no significant difference in acceptability of the concrete or the global ACP approach between countries when adjusted for age and gender. However, age was a significant predictor of acceptability of the concrete ACP approach (2 (2, 123) = 6.32, p = .042), with older participants being less likely to find it acceptable compared to not finding it acceptable (W(8) = 5.50, p = 0.019). Participants preferred the global ACP approach for patients with dementia. A multinomial logistic regression analysis indicated no significant differences in preference between countries when adjusted for age and gender in general. However, Dutch participants were less likely to prefer the global ACP approach (W(8) = 5.18, p = .023). The relationship between country and preference was not influenced by whether participants most strongly considered what the patient with dementia wants for themselves, what the patient’s family wants or what they as the health care provider want for their patient when making medical decisions. ACP is generally regarded as an acceptable form of care for patients with dementia by health care providers across countries. Future research could more specifically determine which cultural or demographic aspects affect health care providers’ views on different ACP approaches.Show less
Background. The elderly population affected by dementia is rapidly increasing, and this rise may lead to more requests for end-of-life interventions like euthanasia, a debated topic worldwide....Show moreBackground. The elderly population affected by dementia is rapidly increasing, and this rise may lead to more requests for end-of-life interventions like euthanasia, a debated topic worldwide. Despite legal restrictions, studies show diverse views on euthanasia acceptability among Japanese and US physicians. Factors like country of practice, religious beliefs, and attitudes toward death have been associated with euthanasia acceptability. Thus, this research aimed to investigate the relationship between country of practice, religion, and attitudes towards death in relation to euthanasia acceptability, while accounting for the influence of age and gender. Methods. The study used a cross-cultural mixed-method design and included 75 participants aged 26 to 71 years. Three separate logistic regression analyses were conducted to measure the influence of these factors on euthanasia acceptability separately. Additionally, a hierarchical multiple regression analysis examined whether the relationship between country of practice and euthanasia acceptability was moderated by religion. Results. The results did not reveal any significant associations between country of practice, religion, attitudes towards death, and euthanasia acceptability. However, there was a significant association between gender and euthanasia acceptability, and results showed that males were more likely to not accept euthanasia as an end-of-life intervention compared to females. Moreover, results showed that the relationship between country of practice and euthanasia acceptability was not moderated by religion. Conclusion. In conclusion, this study suggests that country of practice, attitudes towards death and religiousness, may not be decisive factors in determining euthanasia acceptability, while gender could play a more influential role. These findings serve as an initial step toward understanding the diverse effects of cultural factors on euthanasia acceptability across different countries.Show less
