{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:30:13Z","timestamp":1786480213831,"version":"build-2736575974"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Although qualitative studies suggest that health literacy (HL) may influence engagement in advance care planning (ACP) among patients undergoing dialysis, this association has not been quantitatively examined. We investigated whether multidimensional HL is associated with participation in informal and formal ACP and end-of-life (EOL) care preferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This multicenter cross-sectional study included adult patients receiving hemodialysis from six facilities in Japan. Participation in informal and formal ACP was assessed using a questionnaire, and HL was measured with the Functional, Communicative, and Critical Health Literacy scale. Associations between HL and ACP participation were analyzed using logistic regression models. We also examined patients\u2019 EOL care preferences in the event of serious future health deterioration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 651 eligible patients, 466 were included in the analysis (median age, 71 years; 35% women). Informal ACP participation was reported by 52% of patients, whereas formal ACP participation was 5%. Higher critical HL was independently associated with informal ACP participation (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.25\u20133.00), while higher total HL was associated with formal ACP participation (OR, 4.18; 95% CI, 1.63\u201310.77). Women and diabetes were associated with informal ACP, and female sex with formal ACP. Patients who reported being \u201cunsure\u201d about future treatment preferences had lower total HL and were older (total HL: OR, 0.63; 95% CI, 0.42\u20130.95; age: OR, 0.79; 95% CI, 0.66\u20130.95). The most common reason for not engaging in ACP discussions was a lack of opportunity to discuss ACP (71\/151).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Critical HL was associated with informal ACP participation, whereas overall HL was associated with formal ACP among patients undergoing hemodialysis. In addition, the most frequently reported barrier to ACP engagement was a lack of opportunity for discussion, highlighting the need to both enhance HL and establish structured opportunities for ACP to support patient-centered decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0000001243","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T16:00:31Z","timestamp":1779811231000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Association of Formal and Informal Advance Care Planning with Multidimensional Health Literacy in Patients Undergoing Hemodialysis"],"prefix":"10.34067","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5536-1741","authenticated-orcid":false,"given":"Tomo","family":"Suzuki","sequence":"first","affiliation":[{"name":"Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan"},{"name":"Department of Nephrology, Kameda Medical Center, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0135-599X","authenticated-orcid":false,"given":"Tatsunori","family":"Toida","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan"},{"name":"Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Munakata","sequence":"additional","affiliation":[{"name":"Munakata Clinic, Chiba, Japan"},{"name":"Chikuseikai Munakata Clinic, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2363-4877","authenticated-orcid":false,"given":"Yusuke","family":"Kanakubo","sequence":"additional","affiliation":[{"name":"Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan"},{"name":"Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5322-3374","authenticated-orcid":false,"given":"Mamiko","family":"Ukai","sequence":"additional","affiliation":[{"name":"Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6825-5857","authenticated-orcid":false,"given":"Ryohei","family":"Inanaga","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan"},{"name":"Department of Nephrology, Shin-Yurigaoka General Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6192-7569","authenticated-orcid":false,"given":"Takumi","family":"Toishi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kameda Medical Center, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1693-361X","authenticated-orcid":false,"given":"Tetsuro","family":"Aita","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan"},{"name":"Department of General Internal Medicine and Family Medicine, Fukushima Medical University, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuro","family":"Kawaji","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kameda Medical Center, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2209-260X","authenticated-orcid":false,"given":"Masatoshi","family":"Matsunami","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan"},{"name":"Department of Nephrology, Kameda Medical Center, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4002-3966","authenticated-orcid":false,"given":"Tadao","family":"Okada","sequence":"additional","affiliation":[{"name":"Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4127-7500","authenticated-orcid":false,"given":"Noriaki","family":"Kurita","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan"},{"name":"Department of General Internal Medicine and Family Medicine, Fukushima Medical University, Fukushima, Japan"},{"name":"Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan"},{"name":"Department of Preventive Medicine, Tokai University School of Medicine, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,26]]},"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001243","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:58:03Z","timestamp":1786478283000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":0,"URL":"https:\/\/doi.org\/10.34067\/kid.0000001243","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"2026-01-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-13","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}