Decision-Making Support for People Living With Dementia: A Nationwide Cross-Sectional Study in Diverse Long-Term Care Settings in Japan.

Background: The importance of decision-making support for people living with dementia (PLWD) has been pointed out, but the actual situation has not been fully clarified. This study aimed to describe the implementation of decision-making support for PLWD in three long-term care settings in Japan: hospitals, facilities, and homes.

Methods: A questionnaire survey was conducted among 1000 randomly selected long-term care wards in hospitals (LTCHs), geriatric health service facilities (GHSFs), and home care nursing services (HNSs) between November 2022 and January 2023. Responses were collected using the 15-item decision-making support originally developed. In addition to calculating the implementation rate, the bivariate association between decision-making support implementation and facility characteristics was examined for items with low implementation rates. All analyses were conducted based on the facility type.

Results: The study received 97 (9.7%), 164 (16.4%), and 215 (21.5%) valid responses from LTCHs, GHSFs, and HNSs, respectively. Across all care settings, 'confirm key family's wishes' was the most implemented aspect. In contrast, over half of the facilities did not implement 'support conducting a life review' and 'support expression and execution of wishes' in LTCHs and GHSFs. The implementation rate of these items was higher among facilities providing training on decision-making support and advanced care planning training for staff members.

Conclusions: In all care settings, prioritizing family wishes occurred without assessing the decision-making capacity of PLWD. Training in decision-making support and advanced care planning showed potential for encouraging the implementation of decision-making support for PLWD. However, further investigation is necessary.