Shared decision making for the initiation and continuation of dialysis: a proposal from the Japanese Society for Dialysis Therapy

Shared decision making for the initiation and continuation of dialysis: a proposal from the Japanese Society for Dialysis Therapy

BackgroundIn Japan, forgoing life-sustaining treatment to respect the will of patients at the terminal stage is not stipulated by law. According to the Guidelines for the Decision-Making Process in Terminal-Stage Healthcare published by the Ministry of Health, Labor and Welfare in 2007, the Japanese...

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Bibliographic Details
Published in:Renal replacement therapy Vol. 7; no. 1; pp. 56 - 23
Main Authors: Okada, Kazuyoshi, Tsuchiya, Ken, Sakai, Ken, Kuragano, Takahiro, Uchida, Akiko, Tsuruya, Kazuhiko, Tomo, Tadashi, Hamada, Chieko, Fukagawa, Masafumi, Kawaguchi, Yoshindo, Watanabe, Yuzo, Aita, Kaoruko, Ogawa, Yoshitatsu, Uchino, Junji, Okada, Hirokazu, Koda, Yutaka, Komatsu, Yasuhiro, Sato, Hisamitsu, Hattori, Motoshi, Baba, Toru, Matsumura, Mamiko, Miura, Hisayuki, Minakuchi, Jun, Nakamoto, Hidetomo
Format: Journal Article
Language:English
Published: London Springer Nature B.V 14-10-2021
BMC
Subjects:
Advance care planning
Advance directives
Chronic kidney disease
Clinical decision making
Clinical medicine
Clinical practice guidelines
Cognitive ability
Decision making
Dementia
Dialysis
End-stage kidney disease
Fogo
Health care
Hemodialysis
Hospital administration
Kidney diseases
Palliative care
Patients
Peritoneal dialysis
Shared decision making
Society
United Kingdom > UK
United States > US
Japan
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Summary:BackgroundIn Japan, forgoing life-sustaining treatment to respect the will of patients at the terminal stage is not stipulated by law. According to the Guidelines for the Decision-Making Process in Terminal-Stage Healthcare published by the Ministry of Health, Labor and Welfare in 2007, the Japanese Society for Dialysis Therapy (JSDT) developed a proposal that was limited to patients at the terminal stage and did not explicitly cover patients with dementia. This proposal for the shared decision-making process regarding the initiation and continuation of maintenance hemodialysis was published in 2014. Methods and resultsIn response to changes in social conditions, the JSDT revised the proposal in 2020 to provide guidance for the process by which the healthcare team can provide the best healthcare management and care with respect to the patient's will through advance care planning and shared decision making. For all patients with end-stage kidney disease, including those at the nonterminal stage and those with dementia, the decision-making process includes conservative kidney management. ConclusionsThe proposal is based on consensus rather than evidence-based clinical practice guidelines. The healthcare team is therefore not guaranteed to be legally exempt if the patient dies after the policies in the proposal are implemented and must respond appropriately at the discretion of each institution.
ISSN:2059-1381
2059-1381
DOI:10.1186/s41100-021-00365-5