[Advance Care Planning(ACP)from the Perspective of Homecare Physician]

In Japan, the practice of advance care planning(ACP)for cancer patients may differ from Western countries due to cultural differences and the significant role of family in decision-making. Healthcare providers must consider the physical, psychological, social, and spiritual aspects of care when engaging in ACP, respecting patient autonomy and individual values. Effective communication skills and an understanding of behavioral economics are essential for navigating these discussions, particularly in the home care setting where family caregivers face unique challenges. The discrepancy between patients preferred and actual place of death highlights the need for improved access to and coordination of home-based end-of-life care. As society ages and healthcare resources become limited, ACP should be implemented not only for patients but also for healthcare providers themselves. Horizontal and vertical care coordination, as well as the integration of both, will be key to ensuring sustainable community-based care. ACP in the home care setting offers valuable insights into patients' and families' preferences, emphasizing the importance of collaboration between hospital and community-based healthcare providers. Ultimately, ACP should aim to support the entire community, including patients, families, and healthcare staff, in preparing for and navigating the complexities of end-of-life care.