Japanese Attitudes toward Advance Care Planning for End-of-Life Decisions / General Medicine

ABSTRACT

<B>OBJECTIVE</B> Advance directives that assume respect for individual autonomy in end-of-life decisions may not be accepted in all cultures. We studied Japanese preferences concerning care planning and written advance directives.<BR><B>DESIGN</B> A nationally representative Japanese sample answered questions about their preferred mechanism of care planning and preferences for end-of-life care. Factors associated with wishing to participate in care planning were evaluated by logistic regression.<BR><B>RESULTS</B> Seventy-eight percent of the respondents wanted to be directly involved in care planning. The preferred option for that planning was discussion within the family. The family also emerged as a potential source of knowledge of the patient's values that could inform a physician's decision. Only 23% of respondents desired any type of written advance directive. Greater desire for care planning was related to greater autonomy preference, greater information seeking, greater desire for personal and family decision making, and less willingness to tolerate adverse health states. Women, married subjects, better-educated subjects, and those living alone were more likely to want to participate in care planning.<BR><B>CONCLUSIONS</B> Most Japanese people want to participate in care planning, but the types of written advance directives most commonly used in the U.S. are not suitable. Japanese physicians should provide adequate information about prognosis and should encourage early conversations about preferences for life-sustaining interventions between patients and their family members.