Negotiating end-of-life decision making: a comparison of Japanese and U.S. residents' approaches.
OBJECTIVE
To compare Japanese and U.S. resident physicians' attitudes, clinical experiences, and emotional responses regarding making disclosures to patients facing incurable illnesses.


METHODS
From September 2003 to June 2004, the authors used a ten-item self-administered anonymous questionnaire in a cross-sectional survey of 103 internal medicine residents at two U.S. sites in Los Angeles, California, and 244 general medical practice residents at five Japanese sites in Central Honshu, Kyushu, Okinawa, Japan.


RESULTS
The Japanese residents were more likely to favor including the family in disclosing diagnosis (95% versus 45%, p<.001) and prognosis (95% versus 51%, p<.001) of metastatic gastric cancer. Of residents who favored diagnostic or prognostic disclosure to both the patient and family, Japanese residents were more likely to prefer discussion with the family first. Trainees in Japan expressed greater uncertainty about ethical practices related to disclosure of diagnosis or prognosis. Many Japanese and U.S. residents indicated that they had deceived a patient at the request of a family (76% versus 18 %, p<.001), or provided nonbeneficial care (56% versus 72%, p<.05), and many expressed guilt about these behaviors.


CONCLUSIONS
The residents' approaches to end-of-life decision making reflect known cultural preferences related to the role of patients and their families. Although Japanese trainees were more likely to endorse the role of the family, they expressed greater uncertainty about their approach. Difficulty and uncertainty in end-of-life decision making were common among both the Japanese and U.S. residents. Both groups would benefit from ethical training to negotiate diverse, changing norms regarding end-of-life decision making.
Veteran's Integrated Palliative Program, 11301 Wilshire Boulevard, Mail Code 111G, Los Angeles, CA 90073, USA. bgabbay@mednet.ucla.edu
Baback B
BB
Gabbay
Shinji
S
Matsumura
Shiri
S
Etzioni
Steven M
SM
Asch
Kenneth E
KE
Rosenfeld
Toshiaki
T
Shiojiri
Peter P
PP
Balingit
Karl A
KA
Lorenz
D000328:Adult; D032722:Advance Care Planning; D001291:Attitude of Health Personnel / Q000208:ethnology*; D001293:Attitude to Death / Q000208:ethnology*; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D003657:Decision Making; D005066:Euthanasia, Passive; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007564:Japan; D008297:Male; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011795:Surveys and Questionnaires; D013727:Terminal Care; D014342:Truth Disclosure; D014481:United States