Medical residents in Japan are more likely to involve patients' families in end-of-life decision making--and to favor informing family members over the patients first-- than their United States counterparts, who prefer dealing directly with the patient, according to a new study conducted by Dr. Bob Gabbay and colleagues.

Yet the Japanese medical residents are more conflicted about their approach compared with medical residents in the U.S.

The findings reflect cultural norms in the two countries, said lead researcher Baback B. Gabbay who was a fourth-year medical student at UCLA at the time the study was written. Family ties are stronger in Japan than in the U.S., where a tradition of individualism is more culturally ingrained. However, the degree of uncertainty in the responses of Japanese (medical?) residents may reflect changing cultural norms in Japan.

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

"Negotiating End-of-Life Decision Making: A Comparison of Japanese and U.S. Residents' Approaches" is published in the July issue of Academic Medicine.

The researchers distributed surveys to 244 Japanese and 103 U.S. medical residents. Response rates were 74 percent for the Japanese residents and 71 percent among U.S. residents.

Among the findings:

• 95 percent of Japanese residents said they would inform both patient and family about a metastatic cancer diagnosis, with 99 percent of that group reporting they would notify the family first. By contrast, 53 percent of U.S. residents said they would speak only with the patient and just 2 percent said they would inform the family first.

• 72 percent of the Japanese residents said that both patient and family should be told a metastatic cancer prognosis, with 23 perce
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Contact: Enrique Rivero
erivero@mednet.ucla.edu
310-794-2273
University of California - Los Angeles
25-Jun-2005


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