Work

Adaptation of a workshop for Japanese primary care professionals on dementia‐specific advance care planning communication

Year: 2022

Type: article

Abstract: Despite having the world's oldest population and highest prevalence of persons living with dementia, Japan lags behind Western nations in rates of advance care planning.1, 2 Advance care planning (ACP) is defined as discussions and documentation of patients' preferences for future medical treatment.3 The purpose of this letter is to describe the translation and cultural adaptation of a toolkit to increase its relevance to the Japanese primary care clinician. This letter presents the qualitative domains that emerged during that process to provide insight into the differences between the United States and Japan in dementia-specific advance care planning communication. We translated an existing dementia-specific advance care planning training toolkit for primary care clinicians in the United States by Kistler et al consisting of didactic lectures (see Figure 1), four educational videos, two roleplay activities, and an action planning sheet into Japanese.4 A co-investigator (AK), a native Japanese-speaking, US-trained Family Medicine physician with additional credentialling in Palliative Medicine provided the initial translation. During the translation and adaptation of the content, we documented all adaptations and their rationale. After this initial translation, two other co-investigators, both Japanese-trained Family Medicine physicians (MI and TM) also reviewed the materials and made suggestions for further adaptations. Lastly, the materials were reviewed by a sociologist in Family Medicine (MA) for final adaptations, including subtitling the videos. Two researchers (CK and ML) read the adaptations separately and collaboratively discussed possible domains. Next, they individually coded the adaptations, compared the coding, and discussed any discrepancies until a consensus was reached. Each unique adaptation was assigned a domain and subdomain based on the reasoning for the adaptation. Some adaptations were repeated several times and those were coded as a single domain/subdomain so that only unique adaptations were counted. This work was exempted from Institutional Review Board review. Reasons for adaptations to the dementia-specific advance care planning training toolkit were categorized into the following domains: translation challenge (N = 42), healthcare system for persons living with dementia (N = 31), clarification (N = 28), and difference in medical terminology (N = 10) (see Table 1). The translation challenge domain related to linguistic challenges between English and Japanese and had four sub-domains. The most common subdomains were better translation exists (n = 15), syntax (n = 13), or phrase not used in Japan (n = 12). The healthcare system for persons living with dementia domain related to differences in the healthcare system for persons living with dementia between the United States and Japan and had four subdomains. The most common were due to differences in health policy (n = 17) because of legal differences between the United States and Japanese healthcare systems for persons living with dementia or difference in medical practice (n = 9). The clarification domain had three subdomains and related to adaptations to the wording to increase understanding; most were due to the concept clarification subdomain (n = 22). The difference in medical terminology was the least common domain (n = 10) and related to medicine-specific adaptations. This letter presents the first known adaptation of a dementia-specific US-based advance care planning communication skills training for Japanese healthcare professionals. We found that translation challenges and differences between the two countries in healthcare system for persons living with dementia were the most common challenges requiring adaptation of the original training content. As found in prior work translating Vitaltalk© training into Japanese, we had translation challenges.5, 6 These challenges included adaptations that might change the meaning of content, such as "naming the emotion" which is not a phrase used in Japanese. We also found adaptations due to the Japanese healthcare system such as the lack of legally recognized healthcare power of attorney status, which may reflect underlying cultural issues. A recent narrative review of Japanese community nurses' perspectives similarly found that social, cultural, and legal issues play a significant role in advance care planning.7 These domains may be applicable to other similar cultures, especially East Asian cultures. Primary care clinicians caring for persons living with dementia from these cultures should be mindful that the pressure towards certain phrases or legal documentation might be unexpected by persons living with dementia and their families and could undermine the patient–clinician relationship. Our next steps are to deliver the dementia-specific advance care planning training toolkit in a series of workshops in Japan and to assess its efficacy in teaching dementia-specific advance care planning communication skills to primary care professionals.8 Subsequent work will continue in an iterative fashion and will assess changes in clinicians' confidence pre- and post-workshop. We will continue to make adaptations based on feedback from participants to maximize its relevance for Japanese primary care professionals. Investigators must navigate linguistic and cultural differences to maximize the impact of innovations in the behavioral and communication skills required to optimize healthcare. Christine E. Kistler, Laura Hanson, and Machiko Inoue were involved in the study concept. Christine E. Kistler and Laura Hanson were involved in the study design. Christine E. Kistler, Monique Le Donne, Ayano Kiyota, Tomoko Matsui, Michiko Abe were involved in the acquisition of subjects and data. All authors were involved in data analysis and/or interpretation of data and in preparing the manuscript. No conflicts of interest are reported. The sponsors had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of paper. The training that was the basis for this work was funded by the Gordon and Betty Moore Foundation. Monique Le Donne was supported by a T35 award from the 2022 Medical Students Training in Aging Research (MSTAR) program at UNC-CH NIA 5T35AG038047. Dr. Machiko Inoue was supported by the JSPS Grant-in-Aid for Scientific Research(C) JP19K10531. We acknowledge the Japan-United States Educational Commission and the Fulbright Program.

Source: Journal of the American Geriatrics Society

DOI: 10.1111/jgs.18016