Intrinsic Religious Motivations Influencing Advance Care Planning in Japan: A Mixed-Methods Study

The relationship between advance care planning (ACP) and religious beliefs is controversial in Western countries; a previous study in Japan has shown an association without, however, elucidating its mechanism.

To quantitatively investigate the association between ACP discussions and intrinsic religious motivations and to qualitatively analyze how motives influence discussions in Japan.

An explanatory sequential mixed-methods study 2023-2025 in Japan. Responses were analyzed from 124 religious adults aged 51-84 years participating in Christian and Buddhist religious services in Tokyo, Ibaraki, and Fukushima. The outcome was measured by asking whether respondents had ever discussed ACP; intrinsic motivations were measured using the "Relationship with Transcendence" domain of the Scale of Motives for Faith. Intrinsic motivations were analyzed in relation to the occurrence of discussions using modified Poisson regression models with robust error variance adjusted for possible sociodemographic covariates. Qualitative analysis of 14 in-depth interviews applied constructivist grounded theory to identify how intrinsic motivations influence discussions.

37 respondents (31%) discussed ACP. Respondents with intrinsic religious motivations had a significantly higher prevalence of having had discussions than those without (adjusted prevalence ratio: 2.18, 95% confidence interval: 1.07-4.44). This association was qualitatively explained by the dialectical process of prayer and shared end-of-life experiences within their faith communities and reflection on the meaning of life that engaged them in discussions.

Intrinsic religious motivations facilitate Japanese Buddhists' and Christians' ACP discussions;​ knowing this may help health-care providers develop end-of-life decision-making strategies in palliative care settings.