Background Japan has experienced rapidly ageing as the world’s oldest population. The number of elderly people aged 65 or older accounts for 29% 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 Government policies including advance care planning. To explore and understand Japanese nurses’ cultural perspectives on death and dying, religious beliefs, personal beliefs and professional experiences towards end of life decision making.

Methods Recruited 18 nurses from the large organizations in Tokyo, Hokkaido, Nagoya, Niigata, Kouchi across Japan. Semi structured audiotaped interviews of up to 60 minutes. Interviews conducted face to face or online and transcribed verbatim for analysis. Braun and Clarke Six step process for thematic analysis (2006).

Results Nurses wanting the patient to have a peaceful and good death. Patients and family having emotional conflicts and values with interpersonal relationships. The decision makers at end of life care. Ineffective communication. Cultural influences on decision making. Perspectives of death and dying grounded in Japanese culture.

Conclusion There was a hidden secret which is one of the reasons in Japanese culture. Results showed that connected all cultural aspects to make a decision difficult. The results identified the need to investigate nurses’ role in providing individually focused and quality care, which adopts cultural aspects. Understanding nurse’s perspectives about end of life decision making were the key to implementing patient centered care. This cultural approach can be used and adapted in future research on patients and health professionals in primary healthcare.