Cultural Influences on End of Life Care Decision Making for Older People in Japan

Background/aims: Japan has experienced rapid ageing as the world’s oldest population. The number of older people aged over 65 accounts for 30% of the population. There are complex cultural issues in end of life decision making in Japan including disclosure of diagnosis, providing treatment, Informed consent and advance care planning. The aim was to explore and understand health professionals’ cultural perspectives on death and dying and end of life decision making for older people in Japan.

Methods: This study utilised a qualitative design underpinned by ethnography. Following ethical approval, a number of nurses and physicians were recruited from a large healthcare service in Japan. Semi structured audiotaped interviews were conducted and transcribed for a thematic analysis.

Results: Nurses wanted the patient to have a peaceful and good death. Physicians wanted patient centred care and were trying to achieve good results. There were a number of themes common to both nurses and physicians including emotional conflict, patient centred care and communication manner. There were also some differences between the two groups that centred around decision makings and quality of life care. Overall, the perspectives of death and dying and decision making were grounded in Japanese culture.

Conclusions: Cultural factors substantially influenced the decision making in end of life care in Japan. The results identified the need to investigate health professionals’ role in providing individually focused and quality care that also adopted Japanese cultural aspects for older people. Understanding the healthcare professionals’ perspectives about end of life care decision making were the key to implementing patient centred care for older people in this country