Purpose: The purpose of this study was to clinically implement an advance care planning (ACP) program using existing communication tools between patients and healthcare providers, and to clarify the effectiveness of the intervention. Methods: Cancer patients admitted to 2 departments at a local designated cancer hospital, as well as doctors and nurses, were divided into 2 groups: 9 people in the usual care group (control group), and 9 people in the intervention group utilizing the ACP program using an instruction manual, etc. Then, 6 items related to implementation status, and the effect of the ACP program were analyzed. Results: Regarding the implementation of the ACP program, the implementation rate was 42% (T1, 1 month later), 0% (T2), and 33% (T3). The effect of the ACP program was that discussion between healthcare providers and patients and families (P=0.0027) and care aligned with patient goals (P=0.0027) were significantly higher in the intervention group. Conclusion: By presenting specific behavioral indicators as an ACP program, this study served as a trigger for general ACP behavior among both patients and healthcare providers.

Surrogate decision-making support in the critical care field is a highly challenging form of support owing to its urgency and the fact that families are in crisis situations. Given this context, the diversification of families as a feature of modern society is thought to bring further difficulties to nurses who are involved in surrogate decision-making support. Therefore, this study sought to clarify the content of such support for diverse families that skilled nurses provided in the critical care field. We conducted semi-structured interviews with nine skilled nurses and a qualitative and inductive analysis of the obtained data. We extracted the following five categories of surrogate decision-making support. Even when there was no spare time in the critical care field, skilled nurses operated on the premise that family relationships and values are diverse while (1) “creating a foundation for surrogate decision-making that satisfied families” and (2) “making decisions based on a broad view of family relationships without being bound by preconceptions”, and they realized individualized support by (3) “adjusting the role of surrogate decision-makers based on family characteristics”. In cases where responses were difficult, it became clear that support was provided while (4) “responding to families in accordance with social norms” and demonstrating the ability to (5) “involve medical teams and finds solutions in difficult cases”.[[Please check that this conveys your intended meaning]]

This study aimed to elucidate lifestyle, frailty status, and factors associated with frailty among community-dwelling older adults with heart disease. An anonymous self-administered questionnaire-based survey was sent by mail to 1,277 patients aged 65 or older who were attending an outpatient cardiology department. Survey items covered basic attributes, health and heart disease information, lifestyle, and frailty status. Descriptive statistics, t-tests, and Pearson's product-moment correlations were used to analyze the data. A total of 362 respondents who completed the survey with minimal missing data were included in the analysis. While less than 30% of the respondents maintained a socially engaged lifestyle, over 80% practiced health habits, such as diet and blood pressure management. At least one in four respondents exhibited frailty in motor skills or oral function. The study identified several factors significantly associated with frailty: female sex, poor economic and health status, and lack of healthy dietary or exercise habits. For older adults with heart disease to maintain independent living, it is crucial to manage disease symptoms, maintain oral health, practice dietary habits that prevent malnutrition, and engage in regular exercise aligned with their interests.