ACP is an important initiative in end-of-life care, in which the patient and their family discuss future medical care and support the patient's decision-making. In this study, we clarified the patient and family's preferred place of end-of-life care through ACP, and examined the characteristics of cases in which their wishes were not fulfilled. We surveyed patients who passed away within a year under the medical management of the home medical care service of Ohisamakai Medical Corporation (Kobe City) to investigate the presence or absence of ACP, the patient and family's preferred place of end-of-life care, the actual place of end-of-life care, and the patient's background from medical records. We extracted patients who wished to be at home or a facility as the place of end-of-life care, and analyzed the difference between cases in which their wishes were fulfilled and cases in which their wishes were not fulfilled and they were passed away in a hospital using regression models and partitions. In the results, 30.8% (88/286 cases) of patients were passed away in a hospital without their wishes being fulfilled. Characteristics of these cases included a high number of hospitalizations in the past year, family members living alone, young age at the time of death, and high ability to live independently. Allowing patients to receive end-of-life care at home in accordance with their wishes can also lead to savings in medical expenses, so it is necessary to consider measures to align wishes with reality.
