In Japan as in Hawaii, a growing elderly population must rely on home care, but caregivers feel unprepared for medical decisions near the end of life. Should they encourage a terminal patient with no appetite to accept a feeding tube? Non-therapeutic diagnostic examinations? Artificial ventilation? Intubation to prolong life as far as medically possible? Or accept the natural course of events? Doctors prolong life by “doing everything possible,” yet “everything possible” is often neither painless, productive, nor preferable to patients and families. Decisions about such treatments need to be made while patients are still coherent and competent, but families often resist discussing and deciding such issues until too late. Without an advance care plan (ACP), their loved ones often receive undesirable treatment, leaving unpleasant memories. Prior ACP discussion also improves subsequent resilience of surviving families, but lacking information and stimulus to face these decisions in advance, caregivers postpone choices about the inevitable. We hired Japanese illustrators to create manga showing probable outcomes of each decision for an elderly man. Then we asked home-visiting nurses to use the manga in discussing these situations with patients and their families. Nurses felt that our manga facilitated decision-making, and in some cases relieved the onus of their decisions not to "do everything medically possible". They confirmed that manga deepened their interactions with families, while re-educating the nurses themselves. Our presentation shows clinical cases, examples of use, advantages and dangers of using such manga to educate about advance care planning.

Authors:
Atsuko Ishii, Kyoto College of Nursing Graduate School, Japan
Carl Becker, Kyoto University, Japan
Shigehiko Haeno, Haeno Oushin Clinic, Japan

About the Presenter(s)
Dr. Atsuko Ishii is an Associate Professor of Nursing at the Graduate School of the Kyoto College of Nursing, JPN. Her research focused on family education for elder patients, especially self-determination of family on end-of-life care.

Additional website of interest
https://researchmap.jp/atsuko-ishii

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