|1）Yumiko Kuraoka, Kazuhiro Nakayama: A decision aid regarding long-term tube feeding targeting substitute decision makers for cognitively impaired older persons in Japan: A
small-scale before-and-after study, BMC Geriatrics, 14(16), 1-7, 2014.
BACKGROUND: In Japan, there is no decision-making guide regarding long-term tube feeding that specifically targets individuals making decisions on behalf of cognitively impaired older persons (substitute decision makers). The objective of this study was to describe the development and evaluation of such a decision aid.
METHODS: In this before-and-after study, participants comprised substitute decision makers for 13 cognitively impaired inpatients aged 65 years and older who were being considered for placement of a percutaneous endoscopic gastrostomy tube in acute care hospitals and mixed-care hospitals in Japan. Questionnaires were used to compare substitute decision makers' knowledge, decisional conflict, and predisposition regarding feeding tube placement before and after exposure to a decision aid. The acceptability of the decision aid was also assessed. Paired t-tests were used to compare participants' knowledge and decisional conflict scores before and after using the decision aid. RESULTS: Substitute decision makers showed significantly increased knowledge (P<.001) and decreased decisional conflict (P<.01) regarding long-term tube feeding after using the decision aid. All substitute decision makers found the decision aid helpful and acceptable.
CONCLUSIONS: The decision aid facilitated the decision-making process of substitute decision makers by decreasing decisional conflict and increasing knowledge.
2）"Yumiko Kuraoka, Kazuhiro Nakayama: Factors influencing decision regret regarding placement of a PEG among substitute decision-makers of older persons in Japan: a prospective study, BMC Geriatrics, 17(134), 1-9, 2017.
BACKGROUND: A tube feeding decision aid designed at the Ottawa Health Research Institute was specifically created for substitute decision-makers who must decide whether to allow placement of a percutaneous endoscopic gastrostomy (PEG) tube in a cognitively impaired older person. We developed a Japanese version and found that the decision aid promoted the decision-making process of substitute decision-makers to decrease decisional conflict and increase knowledge. However, the factors that influence decision regret among substitute decision-makers were not measured after the decision was made. The objective of this study was to explore the factors that influence decision regret among substitute decision-makers 6 months after using a decision aid for PEG placement.
METHODS: In this prospective study, participants comprised substitute decision-makers for 45 inpatients aged 65 years and older who were being considered for placement of a PEG tube in hospitals, nursing homes and patients' homes in Japan. The Decisional Conflict Scale (DCS) was used to evaluate decisional conflict among substitute decision-makers immediately after deciding whether to introduce tube feeding and the Decision Regret Scale (DRS) was used to evaluate decisional regret among substitute decision-makers 6 months after they made their decision. Normalized scores were evaluated and analysis of variance was used to compare groups.
RESULTS: The results of the multiple regression analysis suggest that PEG placement (P<.01) and decision conflict (P<.001) are explanatory factors of decision regret regarding placement of a PEG among substitute decision-makers. CONCLUSIONS: PEG placement and decision conflict immediately after deciding whether to allow PEG placement have an influence on decision regret among substitute decision-makers after 6 months."