Attitudes of the Japanese public and doctors towards use of archived information and samples without informed consent: Preliminary findings based on focus group interviews

BACKGROUND: The purpose of this study is to explore laypersons' attitudes toward the use of archived (existing) materials such as medical records and biological samples and to compare them with the attitudes of physicians who are involved in medical research. METHODS: Three focus group interviews were conducted, in which seven Japanese male members of the general public, seven female members of the general public and seven physicians participated. RESULTS: It was revealed that the lay public expressed diverse attitudes towards the use of archived information and samples without informed consent. Protecting a subject's privacy, maintaining confidentiality, and communicating the outcomes of studies to research subjects were regarded as essential preconditions if researchers were to have access to archived information and samples used for research without the specific informed consent of the subjects who provided the material. Although participating physicians thought that some kind of prior permission from subjects was desirable, they pointed out the difficulties involved in obtaining individual informed consent in each case. CONCLUSIONS: The present preliminary study indicates that the lay public and medical professionals may have different attitudes towards the use of archived information and samples without specific informed consent. This hypothesis, however, is derived from our focus groups interviews, and requires validation through research using a larger sample

Patients' preferences for involvement in treatment decision making in Japan

BACKGROUND: A number of previous studies have suggested that the Japanese have few opportunities to participate in medical decision-making, as a result both of entrenched physician paternalism and national characteristics of dependency and passivity. The hypothesis that Japanese patients would wish to participate in treatment decision-making if adequate information were provided, and the decision to be made was clearly identified, was tested by interview survey. METHODS: The subjects were diabetic patients at a single outpatient clinic in Kyoto. One of three case study vignettes (pneumonia, gangrene or cancer) was randomly assigned to each subject and, employing face-to-face interviews, the subjects were asked what their wishes would be as patients, for treatment information, participation in decision-making and family involvement. RESULTS: 134 patients participated in the study, representing a response rate of 90%. The overall proportions of respondents who preferred active, collaborative, and passive roles were 12%, 71%, and 17%, respectively. Respondents to the cancer vignette were less likely to prefer an active role and were more likely to prefer family involvement in decision-making compared to non-cancer vignette respondents. If a physician's recommendation conflicted with their own wishes, 60% of the respondents for each vignette answered that they would choose to respect the physician's opinion, while few respondents would give the family's preference primary importance. CONCLUSIONS: Our study suggested that a majority of Japanese patients have positive attitudes towards participation in medical decision making if they are fully informed. Physicians will give greater patient satisfaction if they respond to the desire of patients for participation in decision-making

がん周術期患者の口腔ケアの有効性に関わる諸要因の検討

〔目的〕がん周術期患者の口腔ケアの有効性と口腔衛生状態の維持および改善に関わる要因について検討した。〔方法〕対象者は初回のがん手術予定があり，術前準備の一環として医科より歯科介入依頼があった成人患者とした。初診時は電子診療録より患者情報，がん治療情報，口腔内評価指標5項目を抽出し，歯周病患者のセルフケアに対する自己効力感測定尺度（SESS）を用いた。手術後の評価は3ヵ月後とし，電子診療録より初診時と同様の口腔内評価指標5項目の抽出と自己効力感測定を行った。術後呼吸器感染症罹患の有無は電子診療録による術後経過，患者から歯科受診日までの肺炎・気管支炎・胸膜炎のいずれかにおける受療の有無や入院歴，治療歴，禁煙状況について聴き取り調査を行った。〔結果〕141名（男性68名，女性73名，平均年齢65.39±11.09歳）を解析対象者とした。3か月後，口腔内評価指標は5項目すべてで有意に改善した（p＜0.001）。術後呼吸器感染症罹患者は認めなかった。2週間以上の術前歯科診療期間（p＝0.002），SESSの変化量（p＝0.001）はプラーク付着状況（PCR）改善に寄与し，糖尿病を有すること（p＝0.004）はPCR悪化に影響していた。自己効力感では総得点（p＜0.001），3つの下位尺度（p＜0.001）すべてで有意に向上した。〔結論〕2週間以上の術前歯科診療期間が確保できることで口腔衛生状態は改善し，術後呼吸器感染症も認めなかった。それに付随して自己効力感の向上にもつながった。［Objective］This study investigated the efficacy of oral care in the perioperative period for patients with cancer and factors associated with the maintenance and improvement of their oral hygiene status.［Methods］The subjects were adult patients with cancer who were scheduled to undergo the first operation and were referred by their physician for dental intervention in preparation for cancer surgery. At the first examination, basic patient data, cancer therapy data, and five items related to oral hygiene were extracted from electronic charts, and the patients were evaluated using the Self-Efficacy Scale for Self-care（SESS）, which was designed to assess self-care in patients with periodontal disease. At the three-month postop-erative assessment, the five oral hygiene assessment items evaluated during the first examination were extracted from electronic charts, and the patients were re-evaluated using the SESS. Electronic charts were reviewed for the postoperative course and data on postoperative respiratory infections. Additionally, the patients were interviewed for any medical consultations required for pneumonia, bronchitis, or pleuri- tis and a history of treatment, hospitalization, or smoking up to the day of dental consultation.［Results］The analysis included 141 patients（68 men, 73 women; mean age: 65.39±11.09 years）. All five oral hygiene items significantly improved three months postoperatively（p＜0 .001）, and no patient had postoperative respiratory infections. Plaque control record（PCR）was improved by preoperative dental care for at least two weeks（p＝0 .002）and a change in the SESS score（p＝0 .001）, and aggravated by diabetes mellitus. In terms of self-efficacy, the total score（p＜0 .001）and the three subscales（p＜0.001）contributed to significant improvement.［Conclusions］Two or more weeks of preoperative dental care improved oral hygiene status, prevented postoperative respiratory infections, and improved self-efficacy in patients scheduled to undergo sur-gery for cancer therapy

How can we promote vaccination of the mass population?-Lessons from the COVID-19 vaccination defaults.

While vaccines are pivotal in combating COVID-19, concerns about side effects and complex procedures have hindered complete vaccination. Prior studies suggest that individuals defaulted to opt-out exhibit higher COVID-19 vaccination rates compared to those in opt-in systems. However, these studies were conducted in countries with a tolerant attitude towards vaccination and default changes, targeting specific age groups, and did not address potential deterrents like the increase in cancellation rates on the day, discomfort towards changing defaults, or the possibility of the opt-out effect being a one-time occurrence. Under the hypothesis that the default nature of the COVID-19 vaccination system influences attitudes towards vaccination even in countries conservative about vaccination and default changes like in Japan, we aimed to examine the differences in the first and second dose vaccination rates, cancellation rates, and the number of complaints between the opt-in and opt-out systems for COVID-19 vaccination. An email survey was conducted in 10 cities in A Prefecture, Japan. The results showed not only higher COVID-19 vaccination rates across all comparable age groups in the opt-out group but also a notably smaller decrease in the second-dose vaccination rate compared to the opt-in group, all achieved without any complaints about the system's introduction. Consequently, it can be inferred that the potential inhibiting factors were largely overcome. Despite some limitations, such as regional specificity, the study suggests that opt-out systems might increase COVID-19 vaccination coverage without leading to significant cancellations or complaints, presenting a promising strategy to facilitate vaccination efforts