Telemedicine and Willingness to Die at Home in Rural and Remote Areas in Japan

Few studies have assessed the potential of telemedicine to improve end-of-life care quality in rural and remote areas. We investigated health care services needed for end-of-life care at home and examined their associations with willingness to die at home, testing the hypothesis that telemedicine facilitates at-home death in rural and remote settings.

A cross-sectional survey was conducted with a target population of 6,382 residents aged ≥20 years living in designated rural and remote areas of Shunan City, Yamaguchi, Japan. Stratified random sampling was employed to select survey participants, resulting in 3,767 individuals who were mailed self-administered questionnaires. First, we assessed health care services needed for end-of-life care at home (telemedicine, home doctor visits, home nursing care, home personal care services, home support services, and senior day care). Multivariable logistic regression analysis was then performed to determine which services were independently associated with willingness to die at home.

Of 3,767 eligible participants, 1,884 (50.0%) responded, and 1,451 were included in the analysis. Among them, 608 (41.9%) were male, 1,166 (80.3%) were aged ≥60 years, and 733 (50.5%) expressed a wish to die at home. Home doctor visits were the most frequently selected service (776 participants [53.5%]), while telemedicine was selected by 193 (13.3%). After adjustment for all measured variables, telemedicine (adjusted odds ratio, 1.41 [95% confidence interval, 1.01-1.98], p = 0.045) and home doctor visits (adjusted odds ratio [OR], 1.50 [95% confidence interval, 1.19-1.90], p < 0.001) were independently associated with willingness to die at home.

These findings suggest that physician-provided services are central to enabling at-home death. Integrating telemedicine with traditional home doctor visits may improve end-of-life care and facilitate at-home death in rural and remote settings.