{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T04:02:48Z","timestamp":1745640168826,"version":"3.40.4"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["19K10543"],"award-info":[{"award-number":["19K10543"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gen and Family Med"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In Japan, legal and social concerns exist about withdrawing life\u2010sustaining treatment (LST) even at the end of life. This study aimed to investigate the experience of physicians and nurses involved in home care with LST withdrawal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A web\u2010based questionnaire survey was conducted among physicians and nurses who were members of the Japanese Association for Home Care Medicine in 2020. The survey collected data on the experience of respondents with withdrawing LST, the decision\u2010making processes involved in withdrawing treatment, and their experience with patients attempting voluntarily stopping eating and drinking (VSED).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Results from 203 respondents, including 150 physicians and 53 nurses, showed that the most commonly withdrawn LSTs were intravenous infusions (115 respondents), tube feeding (69 respondents), and oral administration of medicine (74 respondents). A few respondents withdrew respiratory management, such as mechanical ventilation (11 respondents) or home oxygen therapy (12 respondents). The main diagnoses of patients who had LSTs withdrawn were malignancy, senility, and dementia. Many respondents made decisions through discussions with the families of patients (117 respondents) or multidisciplinary discussions at their facilities (80 respondents). There were 23 respondents who made the decision alone, and they were all physicians. Thirty\u2010two respondents had experience with patients who had completed VSED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>It was found that many Japanese home care physicians and nurses had experienced withdrawal of LSTs, and a significant number among them had experienced patients attempting VSED. Given this situation, there is an urgent need to provide ethics support in Japanese home care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgf2.771","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T12:00:20Z","timestamp":1736856020000},"page":"213-221","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Withdrawal of life\u2010sustaining treatment in Japanese home care: A cross\u2010sectional survey"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7610-498X","authenticated-orcid":false,"given":"Kei","family":"Takeshita","sequence":"first","affiliation":[{"name":"Department of Medical Ethics Tokai University School of Medicine  Isehara City Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5933-5038","authenticated-orcid":false,"given":"Noriko","family":"Nagao","sequence":"additional","affiliation":[{"name":"Kitasato University School of Nursing  Sagamihara City Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshihiko","family":"Dozono","sequence":"additional","affiliation":[{"name":"Graduate School of Humanities and Social Sciences Shizuoka University  Shizuoka City Shizuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiko","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Kamiya Law Office  Chuo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiko","family":"Miura","sequence":"additional","affiliation":[{"name":"Faculty of Nursing Iwate University of Health and Medical Sciences  Morioka City Iwate Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"volume-title":"WMA DECLARATION ON EUTHANASIA AND PHYSICIAN\u2010ASSISTED SUICIDE adopted by the 70th WMA general assembly","year":"2019","author":"World Medical Association","key":"e_1_2_13_2_1"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3917\/jib.214.0135"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12910\u2010020\u201000535\u2010w"},{"key":"e_1_2_13_5_1","unstructured":"Ministry of Health Labor and Welfare.(Internet) About \"Guideline on the decision\u2010making process for medical care at the last stage of life.2007. (Japanese) (cited 2024 June 30) Available from:https:\/\/www.mhlw.go.jp\/shingi\/2007\/05\/s0521\u201011.html"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(06)68946\u20100"},{"key":"e_1_2_13_7_1","unstructured":"The Japan Times.Care of the terminally ill.2006. (Cited 2024 June 30) Available from:https:\/\/www.japantimes.co.jp\/opinion\/2006\/04\/06\/editorials\/care\u2010of\u2010the\u2010terminally\u2010ill\/"},{"key":"e_1_2_13_8_1","unstructured":"Ministry of Health Labor and Welfare.(Internet) About Revision of \"Guideline on the decision\u2010making process for medical and nursing care at the last stage of life\".2018. (Japanese) (Cited 2024 June 30) Available from:https:\/\/www.mhlw.go.jp\/stf\/houdou\/0000197665.html"},{"volume-title":"Edition: the current stage of end\u2010of\u2010life care\u2010from the need for legislation to ACP","year":"2018","author":"Machino H","key":"e_1_2_13_9_1"},{"key":"e_1_2_13_10_1","unstructured":"The Mainichi.(Internet) 70% of key hospitals halted avoided life\u2010prolonging care for some terminal patients: poll.2018. (Cited 2024 June 30) Available from:https:\/\/mainichi.jp\/english\/articles\/20180531\/p2a\/00m\/0na\/007000c"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.34329\/jce.11.0_16"},{"volume-title":"Handbook of health and welfare statistics (fiscal year 2022)","year":"2023","author":"Ministry of Health, Labor and Welfare","key":"e_1_2_13_12_1"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-684X-13-1"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare\u20102017\u2010001426"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41649\u2010023\u201000238\u20105"},{"key":"e_1_2_13_16_1","first-page":"21","volume-title":"Casebook of ethics consultation","author":"Dozono T","year":"2020"},{"key":"e_1_2_13_17_1","unstructured":"The Mainichi Newspapers.Life\u2010prolonging treatment: Fukuoka University Hospital withdrew based on the guideline.2009(Japanese)."},{"key":"e_1_2_13_18_1","unstructured":"Japan Broadcasting Corporation.(Internet) When to remove a ventilator: new choices in medical practice.2017. (Japanese) (cited 2024 June 30) Available from:https:\/\/www.nhk.or.jp\/gendai\/articles\/3985\/"},{"key":"e_1_2_13_19_1","first-page":"23","article-title":"Medical decision\u2010making process for terminally ill patients\u2010advance decision\u2010making for terminally ill patients","volume":"148","author":"Higuchi N","year":"2019","journal-title":"Nihon Ishikai Zasshi"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060520936069"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(12)61034\u20104"}],"container-title":["Journal of General and Family Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgf2.771","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T07:20:56Z","timestamp":1745565656000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgf2.771"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/jgf2.771"],"URL":"https:\/\/doi.org\/10.1002\/jgf2.771","archive":["Portico"],"relation":{},"ISSN":["2189-7948","2189-7948"],"issn-type":[{"type":"print","value":"2189-7948"},{"type":"electronic","value":"2189-7948"}],"subject":[],"published":{"date-parts":[[2025,1,14]]},"assertion":[{"value":"2024-07-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}