Table 3 Issues faced by municipalities in ACP awareness-raising (n = 580, code = 796)

Resources/

Input

1) Medical and nursing care service provision system

Shortage of medical and nursing personnel

11

Lack of resources in home healthcare

50

Coordinating system with medical institutions and medical associations

23

Coordinating system between medical institutions

6

Lack of 24-hour medical institutions and nursing care service offices

10

Coordinating system between medical institutions and long-term care service institutions

14

Coordinating system with other municipalities

2

Home-based end-of-life care delivery system

10

Individual consultation response system

7

2) System for awareness-raising in municipalities

Lack of time

12

Lack of manpower

41

Large burden of coordinating with related institutions

2

Project continuity is difficult

3

Securing financial resources for awareness-raising is difficult

5

Limitations of implementation at municipality-level

7

Creating mechanisms for raising awareness

12

3) Characteristics of local residents

Insufficient and varied awareness of and interest in end-of-life care among residents

36

Obtaining residents’ understanding

7

Residents’ resistance to end-of-life topics

29

Few people wishing to die at home

6

Activities

4) Knowing the target population

Determining resident needs

23

Determining the status of support of medical and nursing care services

11

Determining whether awareness-raising is progressing

5

Issues related to awareness-raising are unclear

4

5) Awareness-raising methods for residents

Content and methods of dissemination to residents

102

Desire to see good examples of activities

8

Selection of awareness-raising targets

6

Timing of awareness-raising for residents

13

Ideal ways of explaining to residents

15

Consideration of dissemination content

33

Lack of dissemination to residents

39

Promotion of awareness of individual help desks

5

Promotion of utilization of at-home courses

4

Securing participants for seminars and lectures

7

Dissemination of long-term care insurance system and local home medical services

2

6) Lecture and workshop planning

Selection of lecture themes and content

6

Selection of lecturers

16

Implementation of interactive workshops

5

Securing means of transportation to venues

2

7) Creation and utilization of media

Promotion of distribution and utilization of created media

23

Creation of explanatory materials and media for residents

7

8) Awareness-raising to related organizations and people

Adjustment and collaboration with related institutions

46

Awareness-raising activities for medical professionals and caregivers

15

Few training sessions

6

Low consciousness and awareness of medical professionals and caregivers

12

Lack of knowledge, experience, and skills among organizers

25

9) Individual decision-making support

Individual response for cases with complicated family relationships

2

Individual response for cases with financial problems

2

Timing of individual support

2

Respect people’s wishes

8

Decision-making support for people with impaired judgment

3

Response when intention changes

2

Care that respects the patient’s wishes after loss of decision-making ability

2

Response when there are differences between the patient’s and their family’s opinions

5

Outputs

10) Evaluation of activities

Setting of evaluation indicators

13

Methods of activities and outcome evaluation

24