Respecting Autonomy in Difficult Medical Settings: A Questionnaire Study in Japan

Hayashi, Miki; Hasui, Chieko; Kitamura, Fusako; Murakami, Masaaki; Takeuchi, Mika; Katoh, Hisao; Kitamura, Toshinori

doi:10.1207/s15327019eb1001_4

Cited by 29 publications

(20 citation statements)

References 14 publications

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“…Japan has a long tradition of physician paternalism [24] as also seen in many other countries [25-27]. Ishiwata suggested that two deeply seated factors are major contributors to the paternalism of Japanese physician – an absence of the spirit of informed consent on the physician's side, and the practice of omakase (entrusting one's care to one's family and physician, on the assumption that they will make the decisions most beneficial or appropriate to oneself) on the patient's side [28].…”

Section: Discussionmentioning

confidence: 99%

Patients' preferences for involvement in treatment decision making in Japan

et al. 2004

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BackgroundA number of previous studies have suggested that the Japanese have few opportunities to participate in medical decision-making, as a result both of entrenched physician paternalism and national characteristics of dependency and passivity. The hypothesis that Japanese patients would wish to participate in treatment decision-making if adequate information were provided, and the decision to be made was clearly identified, was tested by interview survey.MethodsThe subjects were diabetic patients at a single outpatient clinic in Kyoto. One of three case study vignettes (pneumonia, gangrene or cancer) was randomly assigned to each subject and, employing face-to-face interviews, the subjects were asked what their wishes would be as patients, for treatment information, participation in decision-making and family involvement.Results134 patients participated in the study, representing a response rate of 90%. The overall proportions of respondents who preferred active, collaborative, and passive roles were 12%, 71%, and 17%, respectively. Respondents to the cancer vignette were less likely to prefer an active role and were more likely to prefer family involvement in decision-making compared to non-cancer vignette respondents. If a physician's recommendation conflicted with their own wishes, 60% of the respondents for each vignette answered that they would choose to respect the physician's opinion, while few respondents would give the family's preference primary importance.ConclusionsOur study suggested that a majority of Japanese patients have positive attitudes towards participation in medical decision making if they are fully informed. Physicians will give greater patient satisfaction if they respond to the desire of patients for participation in decision-making.

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Section: Discussionmentioning

confidence: 99%

Patients' preferences for involvement in treatment decision making in Japan

et al. 2004

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“…This lack of knowledge may reflect inadequate patient education by health care providers. The medical health care system in Asia is historically a paternalistic one [27, 28]. Singaporean patients, unlike Western patients, tend not to ask questions or actively seek information from health care providers.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Paternal Family History in Hereditary Breast Cancer Is Underappreciated by Health Care Professionals

Yong

Zhou

Lee³

2003

Oncology

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Objectives: Cancer genetics clinics have been established in many major oncology centers worldwide in recent years. For such specialized clinics to fulfill their function, primary care physicians need to identify high-risk patients for referral. Methods: We conducted a survey to evaluate the level of awareness of breast cancer risk factors and hereditary breast cancer among health care providers and patients. Results: 284 health care professionals, 221 medical students, 104 breast cancer patients and 177 cancer-free women participated in the study. Less than half of the patients with breast cancer were aware of their risk for another breast cancer or of the increased breast cancer risk of their sisters and daughters. Less than one quarter of the health care professionals and medical students knew the importance of paternal family history in the evaluation for hereditary breast cancer. Only about half of the health care professionals and medical students and less than one third of the breast cancer patients and cancer-free women knew about genetic testing and prophylactic mastectomy as options for women at risk for hereditary breast cancer. Conclusions: Health care providers and medical students lack basic genetic knowledge and are not aware of emerging diagnostic and preventive options for hereditary breast cancer. Inclusion of cancer genetics in the continuing medical education of health care providers is important to promote such awareness.

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“…Therefore, the fact that someone else was making decisions about a medical treatment that one was receiving was never questioned. This de-pendent model is gradually changing to an autonomous decision-based model [43]; however, legislation mandating information regarding AD to elderly patients over the age of 75 years may be required to break through this psychological dependency. In parallel, providing a common forum within the region for health care providers, care managers, and citizens to discuss successful dying at home will also lead to reformation of awareness.…”

Section: Obstacles Preventing the Effective Function Of Acp: The Highmentioning

confidence: 99%

The Effect of Educational Intervention regarding Advance Care Planning for Advance Directives

Takeshita¹,

Ikeda²,

Sone³

et al. 2015

Health

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This study aimed to examine the effects of empowerment and education intervention to promote Advance Care Planning (ACP) for residents in a highly aged and depopulated region. The study utilized a single-group pre-and post-test design and was conducted in Osakikamijima, Hiroshima, Japan. The researchers and town officials together formed an ACP committee and created an intervention framework. An ACP workshop was held for the participants and a self-administered questionnaire was carried out before, immediately after, and 3 months after the workshop. A total of 125 residents participated in the workshop and 87 of them completed more than 80% of the questionnaire items, whose responses were analyzed as valid responses. The number of participants who completed the AD increased significantly three months after the workshop (p = 0.008). There was a slight increase in the frequency of consultation with the family, but no change was observed in terms of consultation with healthcare providers. The educational intervention increased the respondents' awareness and knowledge of ACP but did not affect the autonomous decision-making process regarding end-of-life care. This strategic process of ACP empowered the residents' awareness and attitude towards end-of-life care with an increased completion rate of AD. On the other hand, cognitive barriers remained toward communication and decision-making shared with healthcare providers. Insufficient consultation with family members also became evident. Therefore, a new intervention strategy which helps increase communication with healthcare providers needs to be formulated and guidelines for consultation with the family and others need to be prepared.

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Respecting Autonomy in Difficult Medical Settings: A Questionnaire Study in Japan

Cited by 29 publications

References 14 publications

Patients' preferences for involvement in treatment decision making in Japan

Patients' preferences for involvement in treatment decision making in Japan

The Importance of Paternal Family History in Hereditary Breast Cancer Is Underappreciated by Health Care Professionals

The Effect of Educational Intervention regarding Advance Care Planning for Advance Directives

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