Thomas Mayers

The COVID-19 pandemic highlighted the need for advance care planning (ACP) as a way to help mitigate the various care concerns that accompanied the healthcare crisis. However, unique obstacles to typical ACP practice necessitated the need for guidance and innovation to help facilitate these vital conversations. The aim of this systematic review was to identify the various ACP barriers and facilitators that arose during the pandemic and determine how ACP practice was affected across different contexts and among different populations. This systematic review (PROSPERO registration number: CRD42022359092), which adheres to the PRISMA guidelines for reporting systematic reviews, examined studies on ACP in the context of the COVID-19 pandemic. The review involved searches of five databases, including MEDLINE and Embase. Of the 843 identified studies, 115 met the inclusion criteria. The extracted ACP barriers and facilitators were codified and quantified. The most frequently occurring ACP barrier codes were: Social distancing measures and visitation restrictions, Uncertainty surrounding the COVID-19 prognosis, and Technological/Telehealth barriers. The most frequently occurring ACP facilitator codes were the following: Telehealth/virtual ACP platforms, Training for clinicians, and Care team collaboration. Identifying the ACP barriers and facilitators is essential for developing effective, resilient ACP promotion strategies and improving its delivery, accessibility, and acceptability.

For non-English-speaking nations such as Japan, proficiency in English has emerged as an indispensable skill, particularly in scientific fields like medicine. This research paper extends prior investigations into the motivations of Japanese medical students for learning English and delves into their willingness to communicate (WTC) in English. Importantly, it explores the impact of the COVID-19 pandemic on these motivations and communication behaviors. This study reveals that Japanese medical students are strongly instrumentally and vocationally motivated, viewing English as a practical asset for their future medical careers. They also exhibit a strong international posture, demonstrating an eagerness to engage with global cultures through English. Notably, the students’ motivation to study English remains resilient despite the pandemic’s challenges, such as the shift to remote learning and travel restrictions. However, their WTC in English exhibits nuanced changes. While overall WTC remains stable, students’ inclination to give presentations in English decreases significantly, possibly due to reduced face-to-face interactions in virtual learning environments. Additionally, their interest in participating in international events and activities wanes, possibly influenced by pandemic-related travel anxiety. These findings underscore the importance of offering specialized English classes and study abroad/international exchange experiences to sustain students’ motivation to learn English.