Learning Objective #1: The leaner will be able to understand awareness of palliative care in remote islands.

Learning Objective #2: The leaner will be able to support older adults in making decision of end-of-life care.

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Background: Palliative care settings are increasing in Japan, however, it is little known about older adult perception of palliative care especially persons who live in remote islands.

Objective: The purpose of this study was to examine awareness of palliative care and preferences for end-of-life care among older adults in Japanese remote islands.

Method: A self-administered questionnaire that included demographics, awareness of hospice and palliative care, preferences for place and end-of-life care (10 items), and possibility of utilizations of palliative care at terminal stage was provided to older adults 60 years and over affiliated with senior centers in Nagasaki, Japan. The questionnaire was distributed to 260 adults. Of these, 198 (76.2%) responded, and 185 fully completed the questionnaire.

Results: The mean age was 71.9, and 97 (52.4%) were male. Perceptions of hospice and palliative care were that 11.4% and 6.9% knew well and 71.6% and 70.5% had heard it but did not know well. Place of terminal care was that 73.1% preferred home, 12.9% hospital, 2.9% palliative care setting, and 11.1% nursing home. Preferences of end-of-life care were shown that palliative cares such as pain control, mental care, and grief care were wanted whereas life-sustaining treatments such as cardiopulmonary resuscitation, artificial ventilation, and tube feeding were refused. After explaining hospice and palliative care, 58.9% were interested in these facilities and 40.8% wanted to use them at end-of-life. Factors associated with interest in palliative care were educational level (p<0.05), perception of hospice and palliative care (p<0.001), and previous discussion about end-of-life issues (p<0.001).

Conclusions: These results suggest that hospice and palliative care were not known among Japanese rural older adults. More than half the participants interested in palliative care, therefore, health care providers have to provide information for senior to choose and receive end-of-life care.