DECISION-MAKING SUPPORT AT THE PATIENT RELATIONS OFFICE OF AN ADVANCED TREATMENT HOSPITAL IN JAPAN

Purpose:

The center for patient relations and clinical ethics (C-PRACE) was established at the University of Tokyo Hospital in 2007. Since its establishment, C-PRACE has provided approximately 3,000 consultations annually. Through these consultations, we discovered that patients, in some cases, explicitly or implicitly needed medical decision-making support. The aim of this study is to describe the decision-making support by C-PRACE’s staffs and identify and clarify the factors that give rise to the need for decision-making support.

Method(s):

A total of 5872 consultations were brought to C-PRACE between April 2013 and June 2015; of these, 62 cases were classified in terms of client demands for decision-making support. A qualitative content analysis was then conducted for the secondary use of these documents.

This study was approved by the Research Ethics Committee of the University of Tokyo, Graduate School of Medicine.

Result(s):

As a result of the classification of the difference of opinion regarding medical care, the most frequent category was 26 cases (41.9%) of “medical therapy,” followed by “treatment by surgery,” (15 cases, 24.2%) and “discharge/changing hospital” (13 cases, 21%). Most consultations (47 cases, 75.8%) were sought by patients or their families, and about 25% were sought by the members of the hospital staff such as physicians or nurses. Of the 47 cases that were sought by patients/their families, about 40% (18 cases) were brought to C-PRACE as complaints. The major causes of clients needing decision-making support were extracted from the analyses: 1) poor communication between physicians and the patient/their families, 2) patient/their families disagreed with the doctor regarding treatment, 3) patient/their families had a poor understanding of the treatment, induced by anxiety about diseases, and 4) patients lacked their mental capacity due to the diseases.

Conclusion(s):

Our results suggest that the necessity of decision-making support was brought about by a lack of communication, in a broad sense. It is not enough to provide decision-making support for patients in Japan. Patient relations offices take a facilitating role of communication between patients and healthcare facilities. Therefore, it is important to incorporate decision-making support as a new role in patient relations offices throughout Japan. A further study would be needed to enhance patient satisfaction by intervening on decision-making support.