Abstract
Background: Increasing evidence has suggested that a person-centred approach (PCA) is beneficial not only for improving care outcomes but also for mitigating the pressure on public health systems. However, policy implementation gaps have prevented the translation of this complex framework into useful practical, ethical and moral stances for end-of-life care (EOLC). This article aims to explore the meaning and implications of person-centredness in EOLC policy discourses.
Methods: By perceiving policy documents as a medium embodied with socio-political and cultural norms, we analysed how PCA in EOLC is constructed within specific socio-cultural contexts and the implications of these contexts on resultant care. Focusing on England and Japan, we conducted a critical policy analysis to examine and compare key policy and legal documents released between 2000 and 2019 in these two post-industrial and socio-culturally distinctive countries.
Results: Our analysis found that the PCA is mobilised in policy discourses primarily through three interconnected dimensions: individual, relational and existential. While acknowledging that both countries have developed varied policy and legal mechanisms to emphasise holistic and integrated care with respect to these three dimensions, we also identified significant gaps in the policies both within and between England and Japan. They include ambiguity in defining patients’ best interests, fragmented support for social and family care and the neglect of existential needs.
Conclusions: This cross-cultural analysis has revealed the complex nature of discourses around PCA in English and Japanese EOLC policies, which often concentrate on the multifaceted aspects of experiences as one approaches the end of life. Despite this, we argue that a more holistic construction of PCA is needed in EOLC policies not only in England and Japan but also more broadly, to encapsulate the richness of end-of-life experiences.
Methods: By perceiving policy documents as a medium embodied with socio-political and cultural norms, we analysed how PCA in EOLC is constructed within specific socio-cultural contexts and the implications of these contexts on resultant care. Focusing on England and Japan, we conducted a critical policy analysis to examine and compare key policy and legal documents released between 2000 and 2019 in these two post-industrial and socio-culturally distinctive countries.
Results: Our analysis found that the PCA is mobilised in policy discourses primarily through three interconnected dimensions: individual, relational and existential. While acknowledging that both countries have developed varied policy and legal mechanisms to emphasise holistic and integrated care with respect to these three dimensions, we also identified significant gaps in the policies both within and between England and Japan. They include ambiguity in defining patients’ best interests, fragmented support for social and family care and the neglect of existential needs.
Conclusions: This cross-cultural analysis has revealed the complex nature of discourses around PCA in English and Japanese EOLC policies, which often concentrate on the multifaceted aspects of experiences as one approaches the end of life. Despite this, we argue that a more holistic construction of PCA is needed in EOLC policies not only in England and Japan but also more broadly, to encapsulate the richness of end-of-life experiences.
| Original language | English |
|---|---|
| Article number | 68 |
| Journal | BMC Palliative Care |
| Volume | 21 |
| Issue number | 1 |
| Early online date | 11 May 2022 |
| DOIs | |
| Publication status | Published - 31 Dec 2022 |
Bibliographical note
Funding Information:We would like to express our sincere gratitude to Professor David Clark (University of Glasgow) and Professor Satoshi Kodama (Kyoto University) for their valuable comments to this article. We are also grateful for colleagues at the End of Life Studies Group at University Glasgow, Shizuoka University, Japanese Red Cross College of Nursing and Okayama University for their ideas and guidance that helped shape this article. Finally, we would like to extend our gratitude to our peer reviewers for their constructive feedback helping us reinforce the academic clarity and methodological soundness of this article. Both authors made a substantial contribution to the conception, design, analysis and interpretation of the policy data. The first author (CF) conducted the analysis of the English end of life care policies and wrote the corresponding sections for England. The second author (MT) conducted the analysis of the Japanese end of life care policies and wrote the corresponding sections for Japan. Both authors wrote the remaining sections in this article and approved the final version to be submitted for publication. Reference to the datasets (policies reviewed) supporting the conclusions of this article are included within the article
Funding Information:
This study has been conducted within the Mitori Project, funded by an ERSC-AHRC UK-Japan SSH Connections grant (ES/S013865/1), Principal Investigator Professor David Clark, Co-investigator Professor Hirobumi Takenouchi. The work in Japan has been supported by the Uehiro Foundation on Ethics and Education (Japan).
Keywords
- Best interests
- End-of-life care
- England
- Existential distress
- Japan
- Person-centred approach
- Policy
- Relationality
ASJC Scopus subject areas
- General Medicine
