Healthcare Providers’ Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study



Most adult patients are willing to discuss advance care planning before the onset of any illness. There might be differences in preferences for timing when it comes to initiating advance care planning discussions by healthcare providers with patients.


To identify healthcare providers’ willingness to initiate advance care planning discussions in Japan.


A mixed-methods questionnaire comprising three case scenarios based on three different illness trajectories.


The study participants were physicians and nurses employed in four community hospitals in Japan.

Main Measures

Percentages of physicians’ and nurses’ willingness to initiate advance care planning discussions at four stages of patients’ illness trajectory were quantitatively determined, and perceptions on preferred timing were qualitatively identified.

Key Results

From 108 physician and 123 nurse respondents (response rate: 99%), 291 physician and 362 nurse responses about three case scenarios were obtained. Overall, 51.2% of physicians and 65.5% of nurses (p < 0.001) accepted discussion before illness. Less than one-third of physicians considered advance care planning a “wise precaution,” while about two-thirds of nurses did. Additionally, more than half of both physicians and nurses preferred to postpone advance care planning until the patient’s imminent death.


Physicians are less willing than nurses to begin advance care planning discussions before patients’ health has deteriorated though most prefer to wait until the patients are close to death. Healthcare providers’ attitudes toward advance care planning will need to be addressed to improve rates of completion in Japan.

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This work was supported by an international joint research grant from the Pfizer Health Research Foundation 2016–2017 (principal investigator: Miyashita).

Author information




Miyashita had full access to all the data collected in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Miyashita, Kohno, Shimizu, Fukuhara, and Yamamoto

Collection of data: Miyashita, Kamihiro, Okawa, and Fujisaki

Analysis and interpretation of data: Miyashita, Kohno, Shimizu, Kashiwazaki, and Yamamoto

Drafting of the manuscript: Miyashita

Critical revision of the manuscript for important intellectual content: Miyashita, Kohno, Shimizu, Kashiwazaki, Kamihiro, Okawa, Fujisaki, Fukuhara, and Yamamoto

Corresponding author

Correspondence to Jun Miyashita PhD.

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The authors declare that they do not have a conflict of interest.

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Prior Presentations

The 3rd Annual Meeting of the Society for Clinical Epidemiology; September 29th 2019; Fukuoka, Japan.

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Miyashita, J., Kohno, A., Shimizu, S. et al. Healthcare Providers’ Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study. J GEN INTERN MED (2021).

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  • advance care planning
  • Japan
  • healthcare provider
  • mixed-methods study