{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T14:20:30Z","timestamp":1788618030053,"version":"build-2803163510"},"reference-count":72,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000272","name":"national institute for health and care research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Lambuth Study Abroad Fund"},{"name":"Japan Student Services Organisation"},{"DOI":"10.13039\/100019485","name":"Univers Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019485","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat&amp;#65533;Care"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Older adults with frailty are at risk of rapid health decline and poor outcomes, including end of life. While advance care planning (ACP) can support person-centred care, how to assess and support older adults\u2019 ACP readiness remains unclear. Health and social care practitioners, and family caregivers, are often main providers of care, but their role in ACP is poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To understand the readiness of older adults with frailty to engage in ACP from the perspectives of older adults, family caregivers, and health and social care practitioners.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>An exploratory qualitative interview study informed by the COM-B system (individual-level behaviour change) and the Ecological Systems Theory (system-level influences).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Semi-structured qualitative interviews with older adults (mild to moderate frailty), unpaid family caregivers, and health and social care practitioners in Japan. The topic guide was informed by the theoretical frameworks, exploring individual- and system-level factors influencing readiness. Reflexive thematic analysis was conducted to generate themes within and across the participant data sets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Twenty-nine interviews were conducted with 32 participants: older adults (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200910), caregivers (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20096), and health (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20096) and social care practitioners (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200910). Three themes were generated: (1) \u2018\n                      <jats:italic toggle=\"yes\">Leave decision-making to family<\/jats:italic>\n                      \u2019 and Bridging family dynamics \u2013 older adults delegate decisions, practitioners navigate complex family relationships; (2) \u2018\n                      <jats:italic toggle=\"yes\">ACP is not part of our rol<\/jats:italic>\n                      e\u2019: Diverging role expectations among practitioners, and hesitation to engage in ACP \u2013 differing perceived practitioners responsibilities limit willingness to initiate ACP; (3) Transitional period: Social norms around death and dying, family structures, and health and social care systems \u2013 shifts in systemic and social aspects shape ACP readiness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>ACP readiness among this population is not solely an individual decision but is shaped by relationships, systemic, and societal factors. Enhancing ACP readiness requires a system-wide approach that incorporates family involvement and interdisciplinary collaboration and is adapted to the local context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26323524251395654","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T07:56:43Z","timestamp":1764403003000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Exploring readiness for advance care planning in Japan: A qualitative interview study with older adults with frailty, family caregivers, and health and social care practitioners in the homecare setting"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2549-2625","authenticated-orcid":false,"given":"Miki","family":"Fujimoto","sequence":"first","affiliation":[{"name":"Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King\u2019s College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8513-5681","authenticated-orcid":false,"given":"Jonathan","family":"Koffman","sequence":"additional","affiliation":[{"name":"Wolfson Palliative Care Research Centre, Hull York Medical School, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4664-580X","authenticated-orcid":false,"given":"Ito","family":"Nagata","sequence":"additional","affiliation":[{"name":"College of Nursing Art and Science, University of Hyogo, Kobe, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiro","family":"Sakaguchi","sequence":"additional","affiliation":[{"name":"School of Human Welfare Studies, Kwansei Gakuin University, Nishinomiya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0034-7402","authenticated-orcid":false,"given":"Catherine J.","family":"Evans","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King\u2019s College London, UK"},{"name":"Sussex Community NHS Foundation Trust, Brighton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2013.03.022"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.M146"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-016-0350-y"},{"key":"e_1_3_3_5_2","article-title":"Total uncertainty: a systematic review and thematic synthesis of experiences of uncertainty in older people with advanced multimorbidity, their informal carers and health professionals","volume":"51","author":"Etkind SN","year":"2022","unstructured":"Etkind SN, Li J, Louca J, et al. 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