Presented at the annual meeting of the Society of General Internal Medicine, April 29, 1999, San Francisco, Calif.
Acculturation of Attitudes Toward End-of-life Care
A Cross-cultural Survey of Japanese Americans and Japanese
Article first published online: 24 JUL 2002
Journal of General Internal Medicine
Volume 17, Issue 7, pages 531–539, July 2002
How to Cite
Matsumura, S., Bito, S., Liu, H., Kahn, K., Fukuhara, S., Kagawa-Singer, M. and Wenger, N. (2002), Acculturation of Attitudes Toward End-of-life Care. Journal of General Internal Medicine, 17: 531–539. doi: 10.1046/j.1525-1497.2002.10734.x
- Issue published online: 24 JUL 2002
- Article first published online: 24 JUL 2002
- cross-cultural comparison;
- terminal care;
- advance directives;
- decision making
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.