title: Japanese cancer patient participation in and satisfaction with treatment-related decision-making: A qualitative study.
abstract: BACKGROUND
  Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Japanese people regarding involvement in treatment-related decision-making are limited. The main objectives of this study were to (1) reveal the actual level of involvement of Japanese cancer patients in the treatment-related decision-making and their overall satisfaction with the decision-making process, and (2) consider the practical implications of increased satisfaction in cancer patients with regard to the decision-making process.
  
  
  METHODS
  We conducted semi-structured interviews with 24 Japanese cancer patients who were recruited from a cancer self-help group in Tokyo. The interviews were qualitatively analysed using the approach described by Lofland and Lofland.
  
  
  RESULTS
  The analyses of the patients' interviews focused on 2 aspects: (1) who made treatment-related decisions (the physician or the patient), and (2) the informants' overall satisfaction with the decision-making process. The analyses revealed the following 5 categories of decision-making: 'patient as the active decision maker', 'doctor selection', 'wilfully entrusting the physician', 'compelled decision-making', and 'surrendering decision-making'. While the informants under the first 3 categories were fairly satisfied with the decision-making process, those under the latter 2 were extremely dissatisfied. Informants' views regarding their preferred role in the decision-making process varied substantially from complete physician control to complete patient control; the key factor for their satisfaction was the relation between their preferred involvement in decision-making and their actual level of involvement, irrespective of who the decision maker was.
  
  
  CONCLUSIONS
  In order to increase patient satisfaction with regard to the treatment-related decision-making process, healthcare professionals in Japan must assess individual patient preferences and provide healthcare accordingly. Moreover, a better environment should be created in hospitals and in society to facilitate patients in expressing their preferences and appropriate resources need to be made available to facilitate their decision-making process.
authors.affiliation: Department of Social Gerontology, School of Public Health, University of Tokyo, Tokyo, Japan. yoshikowatanabe-tky@umin.ac.jp
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Miyako
authors.initials: M
authors.lastname: Takahashi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kai
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010358:Patient Participation / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D014041:Tokyo