Perspectives of Japanese Citizens on Advance Care Planning in Clinical Settings: Findings From a Focus Group Study.

Background: Although advance care planning (ACP) has been vigorously promoted by the Japanese government, it remains unfamiliar to the general public. This study explored citizens' perspectives on ACP conversations in clinical settings using a newly developed handbook to support such discussions. Methods: A qualitative study using four focus group interviews was conducted in March 2024 with 15 citizens aged 53-77, recruited through local networks. Participants included cancer survivors, family caregivers, and individuals with bereavement experiences and/or professional experience in healthcare. The interviews were transcribed verbatim and analyzed thematically. Results: Four main themes emerged: (1) positive responses to ACP, (2) expectations for the broader promotion of ACP, (3) concerns regarding ACP and the use of the Handbook, and (4) real-life experiences related to ACP. Many participants expressed willingness to engage in ACP, and the Handbook was valued as a concrete tool for structuring conversations. Concerns were raised about whether healthcare professionals would have time and readiness to engage in ACP in busy hospital settings, suggesting a misalignment between citizens' openness to ACP and professionals' assumptions about patients' reluctance. Conclusions: This study highlights the perspectives of relatively healthy citizens, an area that remains understudied. A proactive segment of the public willing to engage in ACP was identified. To support this, practical tools such as the Handbook should be accompanied by institutional support and professional readiness. Encouraging dialogue among citizens themselves may further help foster broader social momentum for ACP in Japan.