Japanese medical resident doctors are more likely than their American counterparts to include family members in end-of-life discussions about patients, a new study finds.

The University of California, Los Angeles researchers believe these differences reflect cultural norms between Japan, where family ties are very important, and America, where the culture places more emphasis on the individual.

In their study, researchers sent surveys to 244 Japanese and 103 U.S. medical residents. They garnered a response rate of 74 percent of Japanese residents and 71 percent from the U.S. residents.

The survey found:

• Nearly all (95 percent) of Japanese medical residents said they'd inform both patient and family about a metastatic cancer diagnosis, with 99 percent of that group saying they'd inform the family before they told the patient. In comparison, 53 percent of U.S. residents said they'd speak only with the patient about such a diagnosis and just two percent said they'd inform the family first.
• Nearly three-quarters (72 percent) of Japanese residents said that both the patient and family should be informed of a metastatic cancer prognosis and 23 percent said they'd speak only with the family about such a prognosis. Among U.S. residents, 45 percent said they'd discuss the prognosis only with the patient, while just one percent said they'd inform only the family.
• Seventy-eight percent of Japanese residents who said they had already cared for at least one dying patient during their training said they had withheld a cancer diagnosis from that patient at the family's request. Among U.S. residents, 18 percent said they had done the same thing.

The survey also revealed that Japanese residents had more doubts about their approach than their U.S. counterparts.

The study results reflect the cultural differences between Japan and the United States, said lead researcher Baback B. Gabbay, who was a fourth-year UCLA medical student when the study was conducted. While family ties are stronger in Japan and individualism is more the norm in the United States, the higher amount of uncertainty expressed by Japanese residents may be the result of changing social norms in that country, he said.

"Traditionally, the family in Japan usually decides what to tell the patient. It's different than in the United States, where the individual autonomy to make decisions is perceived as relatively more important," Gabbay said.