A Cross-Cultural Study on Behaviors When Death Is Approaching in East Asian Countries

Abstract

The primary aim of this study was to explore common beliefs and practices when death is approaching in East-Asian countries.A cross-sectional survey was performed involving palliative care physicians in Japan, Korea, and Taiwan. Measurement outcomes were physician-perceived frequencies of the following when patient death was approaching: (1) reluctance to take part in end-of-life discussions, (2) role of family members, (3) home death, and (4) circumstances surrounding death.A total of 505, 211, and 207 responses were obtained from Japanese, Korea, and Taiwan physicians, respectively. While 50% of the Japanese physicians reported that they often or very often experienced families as being reluctant to discuss end-of-life issues, the corresponding figures were 59% in Korea and 70% in Taiwan. Two specific reasons to avoid end-of-life discussion, “bad things happen after you say them out loud” and “a bad life is better than a good death” were significantly more frequently observed in Taiwan. Prioritizing the oldest of the family in breaking bad news and having all family members present at the time of death were significantly more frequently observed in Korea and Taiwan. Half of Taiwanese physicians reported they often or very often experienced the patients/family wanted to go back home to die because the soul would not be able to return from the hospital. In all countries, more than 70% of the physicians reported certain family members were expected to care for the patient at home. At the time of death, while no Japanese physicians stated that they often experienced patients wanted a religious person to visit, the corresponding figure in Korean and Taiwan was about 40%. Uncovered expression of emotion was significantly frequently observed in Korean and Taiwan, and 42% of the Japanese physicians reported family members cleaned the dead body of the patient themselves.There seem to be significant intercountry differences in beliefs and practices when death is approaching in East Asian countries. Future studies on direct observations of patients and families are needed.

Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video‐vignette study (J‐SUPPORT1601)

“…[12][13][14] Even within a single ethnic population, such as the Japanese, people living in Japan are less likely to value knowing what to expect about one's condition in the future and more likely to value leaving the decision to a medical expert than Japanese Americans. The first and most important finding is that explicit prognostic disclosure significantly reduced uncertainty and increased satisfaction without causing increased anxiety in Japanese women with breast cancer.…”

“…Traditionally, nondisclosure of bad news, including a poor prognosis, to a patient has been common practice, and the role of the family in liaising between clinicians and the patient has been emphasized in Asian culture. [12][13][14] Even within a single ethnic population, such as the Japanese, people living in Japan are less likely to value knowing what to expect about one's condition in the future and more likely to value leaving the decision to a medical expert than Japanese Americans. 18 With regard to prognostic disclosure in an incurable cancer setting, those living in Japan are more likely to prefer no disclosure at all than Japanese Americans.…”

“…[7][8][9] Like Western countries, the importance of selfdetermination has increasingly been recognized in several Asian countries; currently, most Asian patients are told of the diagnosis of cancer, and ACP is promoted at a national level. [12][13][14][15] For example, previous surveys in East Asia showed that most physicians would not discuss end-of-life issues, including a poor prognosis, with patients who have advanced cancer. [12][13][14][15] For example, previous surveys in East Asia showed that most physicians would not discuss end-of-life issues, including a poor prognosis, with patients who have advanced cancer.…”

“…[10][11][12] However, disclosure of a poor prognosis is not common in communication with patients of Asian origin who have advanced cancer because nondisclosure of bad news and a family-centered decision-making style remain typical practices in Asian culture. [12][13][14][15] For example, previous surveys in East Asia showed that most physicians would not discuss end-of-life issues, including a poor prognosis, with patients who have advanced cancer. 14,15 Other surveys also revealed that up to 40% to 50% of Japanese and Japanese American people either did not want to discuss the prognosis at all or preferred some level of negotiation with the physician.…”

“…[12][13][14][15] For example, previous surveys in East Asia showed that most physicians would not discuss end-of-life issues, including a poor prognosis, with patients who have advanced cancer. 14,15 Other surveys also revealed that up to 40% to 50% of Japanese and Japanese American people either did not want to discuss the prognosis at all or preferred some level of negotiation with the physician. [16][17][18] Likewise, nondisclosure of a poor prognosis was shown to be favored among Chinese migrant patients with cancer and their families in Australia.…”