Association between person-centred care quality and advance care planning participation in haemodialysis.

Person-centred care (PCC), which incorporates patients' preferences and values for medical care and their life, has been proposed in decision-making for promoting advance care planning (ACP) among patients with kidney failure. Therefore, we aimed to examine variations in PCC across facilities and the association between PCC and ACP participation. This multicentre cross-sectional study included Japanese adults undergoing outpatient haemodialysis at six dialysis centres. The main exposure was PCC, measured using the 13-item Japanese version of the Primary Care Assessment Tool-short form. The main outcome was ACP participation as defined by discussion with the attending physician or written documentation or notes regarding treatment preferences. A general linear model was used to examine the covariates of the quality of PCC. Modified Poisson regression models were used to examine the associations of ACP participation. A total of 453 individuals were analysed; 26.3% of them participated in ACP. Higher PCC was associated with greater ACP participation in a dose-response manner (adjusted prevalence ratios for the first to fourth quartiles: 1.36, 2.31, 2.64 and 3.10, respectively) in respondents with usual source of care (USC) than in those without USC. Among the PCC subdomains, first contact, longitudinality, comprehensiveness (services provided) and community orientation were particularly associated with ACP participation. A maximum of 12.0 points of facility variation was noted in the quality of PCC. High quality of PCC was associated with ACP participation. The substantial disparity in PCC between facilities provides an opportunity to revisit the quality improvement in PCC.

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Competing interests: NK received grants from the Japan Society for the Promotion of Science, consulting fees from GlaxoSmithKline K.K., and payments for speaking and educational events from Taisho Pharmaceutical and Eisai. RI received payments for speaking from Astellas Pharma, Novartis Pharma K.K., and Otsuka Pharmaceuticals. TT received payment for speaking and educational events from Otsuka Pharmaceuticals. MM received payments for speaking and educational events from Astellas Pharma and Baxter. TS has received payment for speaking and educational events from Astellas Pharma, AstraZeneca K.K, Baxter, Bayer Yakuhin, Bristol-Myers Squibb Co., CureApp, Chugai Pharmaceutical, Daiichi Sankyo, Eli Lilly Japan K.K., Janssen Pharmaceutical K.K, Kaneka Medix, Kissei Pharmaceutical, Kowa, Kyowa Kirin, Mochida Pharmaceutical, Nobelpharma, Novartis Pharma K.K., Novo Nordisk Pharm, Ono Pharmaceutical, Otsuka Pharmaceutical, Terumo and Torii Pharmaceutical.