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.
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
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.