title: Palliative Care Physicians' Attitudes Toward Patient Autonomy and a Good Death in East Asian Countries.
abstract: BACKGROUND
  Clarification of the potential differences in end-of-life care among East Asian countries is necessary to provide palliative care that is individualized for each patient.
  
  
  OBJECTIVE
  The aim was to explore the differences in attitude toward patient autonomy and a good death among East Asian palliative care physicians.
  
  
  METHODS
  A cross-sectional survey was performed involving palliative care physicians in Japan, Taiwan, and Korea. Physicians' attitudes toward patient autonomy and physician-perceived good death were assessed.
  
  
  RESULTS
  A total of 505, 207, and 211 responses were obtained from Japanese, Taiwanese, and Korean physicians, respectively. Japanese (82%) and Taiwanese (93%) physicians were significantly more likely to agree that the patient should be informed first of a serious medical condition than Korean physicians (74%). Moreover, 41% and 49% of Korean and Taiwanese physicians agreed that the family should be told first, respectively; whereas 7.4% of Japanese physicians agreed. Physicians' attitudes with respect to patient autonomy were significantly correlated with the country (Japan), male sex, physician specialties of surgery and oncology, longer clinical experience, and physicians having no religion but a specific philosophy. In all 12 components of a good death, there were significant differences by country. Japanese physicians regarded physical comfort and autonomy as significantly more important and regarded preparation, religion, not being a burden to others, receiving maximum treatment, and dying at home as less important. Taiwanese physicians regarded life completion and being free from tubes and machines as significantly more important. Korean physicians regarded being cognitively intact as significantly more important.
  
  
  CONCLUSIONS
  There are considerable intercountry differences in physicians' attitudes toward autonomy and physician-perceived good death. East Asia is not culturally the same; thus, palliative care should be provided in a culturally acceptable manner for each country.
authors.affiliation: Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan. Electronic address: tmorita@sis.seirei.or.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Division of Clinical Psychology, Kyoto University, Kyoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oyama
authors.affiliation: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Shao-Yi
authors.initials: SY
authors.lastname: Cheng
authors.affiliation: Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, South Korea.
authors.forename: Sang-Yeon
authors.initials: SY
authors.lastname: Suh
authors.affiliation: Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Koh
authors.affiliation: Department of Social Welfare, Korea National University of Transportation, Chungju City, South Korea.
authors.forename: Hyun Sook
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Palliative Care Team, Seirei Mikatahara General Hospital, Shizuoka, Japan.
authors.forename: Akemi
authors.initials: A
authors.lastname: Shirado
authors.affiliation: Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003469:Culture; D003643:Death; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D010166:Palliative Care / Q000523:psychology*; D010465:Perception; D026684:Personal Autonomy; D010820:Physicians / Q000523:psychology*; D012067:Religion; D056910:Republic of Korea; D012424:Rural Population; D012727:Sex Characteristics; D013624:Taiwan; D013727:Terminal Care / Q000523:psychology; D014505:Urban Population
keywords: Asia; Culture; autonomy; end of life; good death