# Depression and Advance Care Planning Among Japanese Patients Undergoing Hemodialysis: Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS)

## TL;DR

This study explores how depression affects advance care planning discussions among Japanese dialysis patients, finding a link at one point in time but not over a year.

## Contribution

The study is among the first to examine the relationship between depression and advance care planning in Japanese hemodialysis patients using both cross-sectional and longitudinal analyses.

## Key findings

- Depressive symptoms were positively associated with ACP discussion in cross-sectional analysis.
- The association between depressive symptoms and ACP discussion was not significant in longitudinal analysis.
- Approximately 26-28% of patients had ACP discussions in 2016 and 2017.

## Abstract

Advance care planning (ACP) is crucial in end-of-life care. Data on ACP discussion among patients with end-stage kidney disease are limited. One study has suggested that depressive symptoms increase ACP discussion.

This study aimed to analyze the association between depression and ACP discussion in patients undergoing hemodialysis.

This used data from the Japan Dialysis Outcomes and Practice Patterns Study.

Both cross-sectional and longitudinal associations between depressive symptoms and ACP discussion were examined.

Depressive symptoms were defined as a score of ≥10 points on the 10-item Center for Epidemiologic Studies Depression scale. ACP discussion was defined as discussing ACP with health care providers and family members.

Generalized estimating equations and generalized linear models based on Poisson distribution and log-link function were used to estimate prevalence (PR) and incidence proportion ratios (IPRs) using robust standard errors, respectively.

Data in 2016 and 2017 included 2,443 patients for the cross-sectional analysis and 870 for the longitudinal analysis. ACP discussion was 26% in 2016 and 28% in 2017, with depressive symptoms rates of 45% and 47%, respectively. The cross-sectional analysis indicated a positive association between depressive symptoms and ACP discussion (adjusted PR, 1.20; 95% confidence interval (CI), 1.05-1.37). Depressive symptoms were not significantly associated with ACP discussion in longitudinal analyses (adjusted IPR, 1.10; 95% CI 0.80-1.51).

Sample size, unadjusted confounding, and generalizability across cultural backgrounds.

Our study showed an association between depressive symptoms and ACP in the cross-sectional analysis, but not longitudinally.

Thinking ahead about medical decisions is vital for people receiving dialysis, yet we know little about how often these conversations happen or what drives them. We analyzed national survey data from Japanese dialysis centers to see whether feelings of depression encourage or discourage patients from talking with their families and care teams about future care. We compared patients at one point in time and again 1 year later. At baseline, those reporting depressive feelings were more likely to have had these planning talks, but this link did not hold over the following year. Our work suggests that recognizing emotional distress may open a useful doorway to end-of-life discussions and better patient-centered care for dialysis patients and their supportive networks today.