An experimental study of biases affecting end-of-life medical decisions based on behavioral economics

• Project/Area Number: 16K15302
• Research Category: Grant-in-Aid for Challenging Exploratory Research
• Allocation Type: Multi-year Fund
• Research Field: Medical sociology
• Research Institution: Kobe University
• Principal Investigator: Kizawa Yoshiyuki 神戸大学, 医学部附属病院, 特命教授 (80289181)
• Co-Investigator(Kenkyū-buntansha): 森田 達也 聖隷クリストファー大学, 看護学研究科, 臨床教授 (70513000) ; 吉田 沙蘭 東北大学, 教育学研究科, 准教授 (70636331)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥3,510,000 (Direct Cost: ¥2,700,000、Indirect Cost: ¥810,000); Fiscal Year 2018: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2017: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000); Fiscal Year 2016: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000)
• Keywords: アドバンス・ケア・プランニング / 行動経済学 / 緩和医療学 / 意思決定 / バイアス / フレーミング / アドバンスケアプランイング / 医療・福祉 / 行動学 / 経済学 / 社会学 / 倫理学

Outline of Final Research Achievements

We investigated how readiness for advanced care planning (ACP) varied depending on the way in which　prognostic communication was given and how the ACP was framed. For prognostic communication, it was considered to be undesirable to say, I don't know the prognosis. Other 3 groups were all similar.For framing, it was suggested that doing a loss-framing would promote ACP and reduce uncertainty rather than a gain-framing. However, there was no significant difference in the method of prognostication and framing for the primary endpoint of this study, readiness for ACP, between the groups.

Academic Significance and Societal Importance of the Research Achievements

予後の伝え方としては、「予後はわかりません」と伝えることは好ましくない。「平均値および範囲を伝える」、「予後曲線のグラフを用いて伝える」、「PSの変化を示すグラフを用いて伝える」はいずれも同等だった。フレーミングとしては損失フレーム（ACPをしておかないとこんな困ったことが起こるかもしれません）をしたほうが、利得フレーム（ACPをするとこんないいことがあります）よりも、ACPが促進されて不確実性が減る可能性が示唆された。今後はこの行動経済学の知見を取り入れたACPのプログラムを開発し、その患者/家族に対する効果を検証する必要がある。

Research Products

• [Journal Article] 特集 人を生かし自分を活かす 意思決定支援とACP 話し合いの手引き 「意思決定支援とACP」の基本的知識とエビデンス 「人生の最終段階における医療・ケアの決定プロセスに関するガイドライン」と意思決定支援のプロセス (2020)
  • Author(s): 木澤 義之
  • Journal Title: 看護管理 Volume: 30 Pages: 108-112
• [Journal Article] Effects of Brief Nurse Advance Care Planning Intervention with Visual Materials on Goal-of-Care Preference of Japanese Elderly Patients with Chronic Disease: A Pilot Randomized-Controlled Trial (2020)
  • Author(s): Kizawa Yoshiyuki、Okada Hiroko、Kawahara Takuya、Morita Tatsuya
  • Journal Title: Journal of Palliative Medicine Volume: 23 Issue: 8 Pages: 1076-1083
  • DOI: 10.1089/jpm.2019.0512
  • Peer Reviewed
• [Journal Article] Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study (2020)
  • Author(s): Hamano Jun、Oishi Ai、Morita Tatsuya、Kizawa Yoshiyuki
  • Journal Title: BMC Palliative Care Volume: 19 Issue: 1 Pages: 32-32
  • DOI: 10.1186/s12904-020-00543-y
  • NAID: 120006826793
  • Peer Reviewed / Open Access
• [Journal Article] Effects of End-of-Life Discussions on the Mental Health of Bereaved Family Members and Quality of Patient Death and Care. (2017)
  • Author(s): Yamaguchi T, Kizawa Y, et.al.
  • Journal Title: J Pain Symptom Manage. Volume: 54 Pages: 17-26
  • Peer Reviewed
• [Journal Article] Advance care planning for adolescent patients with life-threatening neurological conditions: a survey of Japanese paediatric neurologists. (2017)
  • Author(s): Yotani N, Kizawa Y, Shintaku H.
  • Journal Title: BMJ Paediatr Open. Volume: 28 Issue: 1 Pages: e000102-e000102
  • DOI: 10.1136/bmjpo-2017-000102
  • NAID: 120006619815
  • Peer Reviewed / Open Access
• [Journal Article] End-of-life care and discussions in Japanese geriatric health service facilities: A nationwide survey of managing directors’ viewpoints. (2017)
  • Author(s): Kanoh A, Kizawa Y, Tsuneto S, Yokoya S.
  • Journal Title: Am J Hosp Palliat Care Volume: ー Issue: 1 Pages: 83-91
  • DOI: 10.1177/1049909117696203
  • Peer Reviewed
• [Journal Article] Differences between Pediatricians and Internists in Advance Care Planning for Adolescents with Cancer (2017)
  • Author(s): Yotani N, Kizawa Y, Shintaku H.
  • Journal Title: J Pediatr Volume: ー Pages: 356-362
  • DOI: 10.1016/j.jpeds.2016.11.079
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Benefits of the Japanese version of the advance care planning facilitators education program. (2017)
  • Author(s): Miura H, Kizawa Y, Bito S, Onozawa S, Shimizu T, Higuchi N, Takanashi S, Kubokawa N, Nishikawa M, Harada A, Toba K.
  • Journal Title: Geriatr Gerontol Int. Volume: 17 Issue: 2 Pages: 350-352
  • DOI: 10.1111/ggi.12814
  • Peer Reviewed
• [Presentation] Advance Directive & Advance Care Planning in Japan: focusing on education for health care professionals (2018)
  • Author(s): Yoshiyuki Kizawa
  • Organizer: アドバンス・ケア・プランニングの現状と課題
  • Int'l Joint Research / Invited
• [Presentation] 意思決定支援～私たち医療者ができることの具体を討論する～ (2018)
  • Author(s): 木澤義之
  • Organizer: アドバンス・ケア・プランニングの現状と課題
  • Invited
• [Presentation] 意思決定支援～私たち医療者ができることの具体を討論する～ (2018)
  • Author(s): 木澤義之
  • Organizer: 第14回日本クリティカルケア看護学会学術集会
  • Invited
• [Presentation] アドバンス・ケア・プランニングの現状と課題 (2018)
  • Author(s): 木澤義之
  • Organizer: 第14回日本クリティカルケア看護学会学術集会
  • Invited
• [Presentation] アドバンス・ケア・プランニング（ACP）のビデオ上映会：アンケート調査の総括. (2018)
  • Author(s): 森雅紀
  • Organizer: 第7回膵がん教室ワークショップ in 福岡
  • Invited