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Acculturation of attitudes toward end-of-life care

A cross-cultural survey of Japanese Americans and Japanese

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Abstract

OBJECTIVE: Cross-cultural ethical conflicts are common. However, little is known about how and to what extent acculturation changes attitudes toward end-of-life care and advance care planning. We compared attitudes toward end-of-life care among Japanese Americans and Japanese in Japan.

DESIGN: Self-administered questionnaire in English and Japanese.

SETTING AND PARTICIPANTS: Community-based samples of Japanese Americans in Los Angeles and Japanese in Nagoya, Japan: 539 English-speaking Japanese Americans (EJA), 340 Japanese-speaking Japanese Americans (JJA), and 304 Japanese living in Japan (JJ).

MEASUREMENTS AND MAIN RESULTS: Few subjects (6% to 11%) had discussed end-of-life issues with physicians, while many (EJA, 40%; JJA, 55%; JJ, 54%) desired to do so. Most preferred group surrogate decision making (EJA, 75%; JJA, 57%; JJ, 69%). After adjustment for demographics and health status, desire for informing the patient of a terminal prognosis using words increased significantly with acculturation (EJA, odds ratio [OR] 8.85; 95% confidence interval, [95% CI] 5.4 to 14.3; JJA, OR 2.8; 95% CI 1.8 to 4.4; JJ, OR 1.0). EJA had more-positive attitudes toward forgoing care, advance care planning, and autonomous decision making.

CONCLUSION: Preference for disclosure, willingness to forgo care, and views of advance care planning shift toward western values as Japanese Americans acculturate. However, the desire for group decision making is preserved. Recognition of the variability and acculturation gradient of end-of-life attitudes among Japanese Americans may facilitate decision making and minimize conflicts. Group decision making should be an option for Japanese Americans.

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Authors and Affiliations

  1. the Division of General Internal Medicine and Health Services Research, University of California-Los Angeles, Los Angeles, Calif

    Shinji Matsumura MD, MSHS, Honghu Liu PhD, Katharine Kahn MD &  Neil Wenger MD, MPH

  2. the School of Public Health and Asian American Studies, University of California-Los Angeles, Los Angeles, Calif

    Marjorie Kagawa-Singer RN, PhD

  3. National Tokyo Medical Center, University of Tokyo, Tokyo, Japan

    Seiji Bito MD, MSHS

  4. the Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Shinji Matsumura MD, MSHS & Shunichi Fukuhara MD, PhD

Authors
  1. Shinji Matsumura MD, MSHS
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  2. Seiji Bito MD, MSHS
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  3. Honghu Liu PhD
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  4. Katharine Kahn MD
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  5. Shunichi Fukuhara MD, PhD
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  6. Marjorie Kagawa-Singer RN, PhD
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  7. Neil Wenger MD, MPH
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Corresponding author

Correspondence to Neil Wenger MD, MPH.

Additional information

This study was supported in part by a grant from the VA/UCLA/RAND Medical Treatment Effectiveness Program (MEDTEP) Center for Asians and Pacific Islanders that was funded by Agency for Health Care Policy Research (P50HS07370). Additional project support was provided by Pfizer Foundation Grants to Support Joint International Research Projects in Japan.

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Matsumura, S., Bito, S., Liu, H. et al. Acculturation of attitudes toward end-of-life care. J GEN INTERN MED 17, 531–539 (2002). https://doi.org/10.1046/j.1525-1497.2002.10734.x

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