Japanese citizens' attitude toward end‐of‐life care and advance directives: A qualitative study for members of medical cooperatives

Background Japanese citizens are interested in choosing their own end-of-life care, but few have created their own advance directive. This study examined changes among Japanese citizens' attitudes toward end-of-life care and advance directives and explored factors that affected these attitudes. Methods We conducted five focus groups with 48 participants in 2009 and 2010. All participants were members of health cooperatives in Tokyo. Results We identified many barriers and reasons for creating and writing down advance directives. Experience caring for dying people and having a serious disease affected attitudes toward advance directives. Some participants changed their attitude toward end-of-life care by writing their own advance directive. Conclusions When someone is writing advance directives, asking about his/her past experience of caring may be helpful. And learning about or filling out advance directives may help to break down resistance to using these documents.