Ichiro Kai

Disclosure preferences regarding cancer diagnosis and prognosis: to tell or not to tell?

Telling people that they have cancer has a great impact on their lives, so many doctors are concerned about how they should inform patients about a cancer diagnosis and its prognosis. We conducted a general population survey in Japan to investigate people’s preferences on receiving this information. There were no significant differences in respondents’ preferences according to the seriousness of the cancer. Full disclosure of the diagnosis was preferred by 86.1% of the respondents, while 2.7% wanted non-disclosure. As for the initial provision of information, the majority preferred partial disclosure concerning the prospects of complete recovery (64.5%) and the expected length of survival (64.1%). Those who responded negatively to the statement, “If I am close to the end of my life, I want to be informed of the fact so I can choose my own way of life”, were more likely to want non-disclosure on diagnosis. The results suggest that, at the first opportunity of providing information, a disclosure policy of giving patients full details of their diagnosis and some information on prognosis can satisfy the preferences of most patients. Contrary to popular belief, the seriousness of the cancer and people’s demographic characteristics displayed little impact in this study.

Leisure and religious activity participation and mental health: gender analysis of older adults in Nepal

BackgroundInvolvement in activities has been found to be beneficial for improving quality of life and successful aging for older adults. Little is known, however, about the involvement in activities and depression of older adults in Asian developing countries. This study explores whether participation in leisure social and religious activities are related to depression and satisfaction with life in older adults of Nepal. Gender differences are also explored.MethodsThe study sample was derived from a survey which aimed to determine the intergenerational relationships between older adults and their married sons. A cross-sectional quantitative study of older adults sixty years and over in Nepal was conducted with face-to-face interviews using structured instruments. A convenience sample of 489 community dwelling older adults, 247 men and 242 women, were included in the study. The dependent variables, depression and satisfaction with life, were measured by the Geriatric Depression Scale (GDS) and Satisfaction With Life Scale (SWLS) respectively. Age, gender, marital status, education, perceived health, financial satisfaction, social support received and provided by older adults, and social activity were independent variables in the study.ResultsSaying prayers (B = -2.75; p < 0.005), watching television and listening to the radio (B = -1.88; p < 0.05), and participating in physical activity (B = -1.05; p < 0.05) correlated to lower depression for older men, but only watching television and listening to the radio (B = -2.68; p < 0.005) related to lower rates of depression for women. Socializing with others (B = 1.22; p < 0.05) was related to higher satisfaction with life for men, but for women visiting friends (B = 1.29; p < 0.05), socializing with others (B = 1.45; p < 0.005), and watching television and listening to the radio (B = 0.92; p < 0.05) related to improved satisfaction with life. Activity engagement significantly improved mental health in older adults.ConclusionSpecific activity participation was a significant correlate of lower levels of depression and higher levels of satisfaction with life among older adults in Nepal. The findings explore the need for further research on activity participation in developing countries so that it can be useful for health care practioners and those involved with the activities of aged populations in developing countries.

Social support exchange and quality of life among the Korean elderly

This study examined the impact of providing and receiving support on thequality of life (QOL) of the elderly. Trained interviewers conductedface-to-face interviews with 714 rural community residents aged 60 andover in Korea. Subjects were asked a series of structured questionsincluding age, sex, living arrangement, physical functions, and thefrequency of providing and receiving support in their network (spouse,children, and friends). The Philadelphia Geriatric Center Morale Scalewas used to measure degree of QOL. Results indicated that respondentshad family-centered support networks. We found a significant correlationbetween support and physical functions and, less strongly, betweensupport and age. When physical function was controlled, ANOVAs (Analysesof Variance) showed that providing support to their children and friendswas more strongly related to QOL score than receiving support from thein both males and females. Overall, the elderly who exchanged supportfrequently, both providing and receiving support, showed the highest QOLin most situations. Researchers and policy makers should explore thepotential benefits of providing support as well as receiving support.

Perspectives on advance directives in Japanese society: A population-based questionnaire survey

BackgroundIn Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan.MethodA self-administered questionnaire was sent via mail to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution.ResultsOf the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret ones directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will.ConclusionsWritten ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure.

Leisure activities and cognitive function in elderly community-dwelling individuals in Japan: A 5-year prospective cohort study

OBJECTIVE This study aimed to clarify the longitudinal relationship between leisure activities and cognitive decline among Japanese community-dwelling older adults, using a 5-year prospective cohort study design. METHODS A total of 567 men and women, aged 70years and over, participated in the study. The Mini-Mental State Examination was used in baseline and follow-up surveys to assess cognitive function. The change in cognitive function from baseline to follow-up was determined, and cognitive decline over 5years was used as the outcome variable. Leisure activities (hobby, social activity, and physical activity) were assessed at baseline and used as independent variables. Age, gender, number of years of education, presence of chronic diseases, instrumental activities of daily living, depressive symptoms, smoking, hearing deficits, and level of cognitive function at baseline were used as covariates. RESULTS Multivariate logistic regression analysis, adjusted for potential confounders, showed that non-participation in a hobby was significantly and independently associated with cognitive decline (odds ratio: 1.87, 95% confidence interval: 1.16-3.02, p<0.01). There were no significant relationships between social activity, physical activity and cognitive decline. CONCLUSIONS Our study found a longitudinal inverse relationship between hobby participation and cognitive decline among elderly Japanese community-dwelling individuals, suggesting that engaging in a hobby in later life can contribute to preserving cognitive function.

Impact of communicative and critical health literacy on understanding of diabetes care and self-efficacy in diabetes management: a cross-sectional study of primary care in Japan

BackgroundThe role of a patient’s functional health literacy (HL) has received much attention in the context of diabetes education, but researchers have not fully investigated the roles of communicative and critical HL, especially in primary care. Communicative HL is the skill to extract health information and derive meaning from different forms of communication, and to apply this information to changing circumstances. Critical HL allows the patient to critically analyze information and to use this information to achieve greater control over life events and situations. We examined how HL, particularly communicative and critical HL, is related to the patient’s understanding of diabetes care and self-efficacy for diabetes management in primary care settings. We also examined the impact of patient–physician communication factors on these outcomes, taking HL into account.MethodsWe conducted a cross-sectional observational study of 326 patients with type 2 diabetes who were seen at 17 primary care clinics in Japan. The patients completed a self-administered questionnaire that assessed their HL (functional, communicative, and critical), understanding of diabetes care, and self-efficacy for diabetes management. We also examined the perceived clarity of the physician’s explanation to assess patient–physician communication. Multivariate regression analyses were performed to determine whether HL and patient–physician communication were associated with understanding of diabetes care and self-efficacy.ResultsA total of 269 questionnaires were analyzed. Communicative and critical HL were positively associated with understanding of diabetes care (β = 0.558, 0.451, p < 0.001) and self-efficacy (β = 0.365, 0.369, p < 0.001), respectively. The clarity of physician’s explanation was associated with understanding of diabetes care (β = 0.272, p < 0.001) and self-efficacy (β = 0.255, p < 0.001). In multivariate regression models, HL and perceived clarity of the physician’s explanation were independently associated with understanding of diabetes care and self-efficacy.ConclusionsCommunicative and critical HL and clear patient–physician communication were independently associated with the patient’s understanding of diabetes care and self-efficacy. The potential impact of communicative and critical HL should be considered in communications with, and the education of, patients with diabetes in primary care settings.

Reconsidering Evaluation Criteria for Scientific Adequacy in Health Care Research: An Integrative Framework of Quantitative and Qualitative Criteria

It is important to reconsider evaluation criteria regarding scientific adequacy in health care research. In this article the authors review the four pairs of quantitative/qualitative paradigms. They discuss the use of evaluation criteria based on a pragmatic perspective after examining the epistemological issues behind the criteria. Validity/credibility is concerned with research framework, whereas reliability/dependability refers to the range of stability in observations, objectivity/ confirmability reflects influences between observers and subjects, and generalizability/transferability has epistemological differences in the way findings are applied. Qualitative studies should not always choose qualitative paradigms, and vice versa. If stability can be assumed to some extent in a qualitative study, it is better to use a quantitative paradigm. Regardless of whether it is quantitative or qualitative research, it is important to recognize the four epistemological axes.

Truth telling in the case of a pessimistic diagnosis in Japan

We investigated how physicians in Japan convey a poor prognosis of advanced cancer. Physicians tended to give patients optimistic accounts of their prognosis, while they were inclined to give the families pessimistic accounts.

The Female Sexual Function Index (FSFI): Development of a Japanese Version

INTRODUCTION A valid and reliable self-administered scale to measure multidimensional aspects of female sexual function is needed in Japan, as sexual dysfunction is quite common in Japanese women. AIM The aim of this paper is to develop a Japanese translation of the Female Sexual Function Index (FSFI-J), 3-month version, and to measure its psychometric reliability and validity. METHODS Following a language validation process and pilot tests, we modified the scale by adding some instructions and answer options. A cross-sectional survey to examine psychometric reliability and validity of FSFI-J was conducted with 126 healthy Japanese women in partnered relationships. Reliability studies on test-retest and on internal consistency were conducted using the intraclass correlation coefficient (ICC) and Cronbachs α coefficient, respectively. A validity study was conducted on aspects of face, construct, concurrent, and discriminant validity. MAIN OUTCOME MEASURES The main outcome is the psychometric reliability and validity of FSFI-J. RESULTS FSFI-J showed high test-retest reliability (ICC > 0.78) and high internal consistency (Cronbachs α > 0.84). In terms of face validity, FSFI-J was found to be understandable and can adequately measure various aspects of female sexual function. Regarding construct validity, exploratory factor analysis of FSFI-J supported a five-factor solution, consisting of desire/arousal, lubrication, orgasm, satisfaction, and pain. This domain structure was identical to that of the original FSFI. Regarding concurrent validity, FSFI-J total score and domain scores showed significant correlations (Pearsons r = -0.613 for total score) with the sexual function domain of the perimenopausal subjective symptom inventory and overall sexual satisfaction as measured by a visual analog scale (Pearsons r = 0.387). For discriminant validity, the regular menstruation group showed significantly higher FSFI-J scores than the menopause group in the total score and all subdomain scores except sexual satisfaction. CONCLUSIONS The FSFI-J is a valid and reliable instrument to measure multidimensional aspects of sexual function in healthy Japanese women who are in partnered relationships.

Factors associated with intentions to adhere to colorectal cancer screening follow-up exams.

BackgroundTo increase adherence rate to recommendations for follow-up after abnormal colorectal cancer (CRC) screening results, factors that inhibit and facilitate follow-up must be identified. The purpose of this study was to identify the factors associated with intention to adhere to CRC screening follow-up exams.MethodsDuring a 4-week period in October 2003, this survey was conducted with 426 subjects participating in a community-based CRC screening program in Nagano, Japan. Study measures included intention to adhere to recommendation for clinical follow-up in the event of an abnormal fecal occult blood test (FOBT) result, perceived susceptibility and severity of CRC, perceived benefits and barriers related to undergoing follow-up examination, social support, knowledge of CRC risk factors, health status, previous CRC screening, personality and social demographic characteristics. Univariate and multivariate logistic regression analyses on intention to adhere to recommendations for follow-up were performed.ResultsAmong the 288 individuals analyzed, approximately 74.7% indicated that they would definitely adhere to recommendations for follow-up. After controlling for age, gender, marital status, education, economic status, trait anxiety, bowel symptoms, family history of CRC, and previous screening FOBT, analyses revealed that lower levels of perceived barriers, higher levers of perceived benefits and knowledge of CRC risk factors were significantly associated with high intention respectively.ConclusionThe results of this study suggest that future interventions should focus on reducing modifiable barriers by clarifying misperceptions about follow-up, promoting the acceptance of complete diagnostic evaluations, addressing psychological distress, and making follow-up testing more convenient and accessible. Moreover, educating the public regarding the risk factors of CRC and increasing understanding of the benefits of follow-up is also important.