Rate of advance care planning practice during the COVID-19 outbreak in Japan: a cross-sectional survey study

Advance care planning (ACP) ensures that future care is provided during serious illness, considering an individual's wishes; it is particularly important for older adults. Regarding ACP practices during the coronavirus disease (COVID-19) outbreak, although there are reports on patients, reports on geriatricians are scarce.

This study evaluated the rate of ACP practice during the COVID-19 outbreak through a questionnaire survey of geriatricians.

This cross-sectional study surveyed geriatric specialists, who were members of the Japanese Geriatric Society, between October and December 2022 using an anonymous online questionnaire. The questionnaire covered the treatment of COVID-19 patients, difficulties encountered when caring for older patients with COVID-19 infection, and COVID-19 sequelae. Multiple logistic regression with a forward stepwise method was performed to determine the factors associated with ACP practices.

Of the 258 surveyed doctors, 74 (28.7%) practiced ACP. Multiple logistic regression identified that age 20-49 years and experience in treating (or visiting facilities to treat) patients with COVID-19 infection were factors related to doctors that were significantly and positively associated with ACP practice. Additionally, a significant decline in the patients' cognitive functions and difficulties in preventing COVID-19 infection were positively associated with ACP practiced by doctors.

This study suggested that ACP should be practiced for older patients with dementia before COVID-19 infection, which would worsen their dementia symptoms. Moreover, ACP should be emphasized for older patients admitted to facilities. Our results could help devise effective measures to facilitate ACP practices.