Japanese patients want more involvement in making treatment decisions

The paternalistic attitude of Japanese physicians towards their patients is outdated. According to a new study in BMC Family Practice, patients in Japan want to play a more active role in making decisions about their treatment.

The study found that, “the majority of Japanese patients have positive attitudes towards participation in medical decision making if adequate information is provided”. 30% of those questioned went as far as saying that they would like to have the final say on which treatment they receive, if their preference conflicted with the physician’s recommendations.

These results are perhaps surprising given how passive the role of patients in Japan currently is. Japanese physicians frequently fail to impart medical information to their patients for fear that they will misunderstand it and become anxious. It is also common for a physician to inform patients’ families of ‘bad news’ first, and ask the family to decide whether the patient should know their prognosis, in the belief that this is the kindest way to proceed.

In many case, patients do not like to ask for withheld information, even when they want to be told the truth. Given these circumstances, it has been the long held belief that Japanese patients prefer to take a passive role, and delegate decision-making responsibility to their physicians and family.

Researchers from Kyoto University Graduate School of Medicine gave the 134 outpatients who participated in the study a short description of possible symptoms for one of three conditions: pneumonia, gangrene and cancer. The researchers presented the volunteers with diagnoses, treatment options and a prognosis, and subjects were interviewed to gauge their desire to participate in decisions regarding their medical care.

71% of volunteers said that under the hypothetical circumstances they would like to make treatment decisions in collaboration with their physician. 16% of patients would prefer that their family or the physician made these decisions on their behalf, though this figure was significantly higher in the group of patients who were presented with the cancer scenario.

Japanese patients know that admission to hospital may impose heavy burdens on their families. Perhaps this is why many of the participants said that they would like their families to be involved in making treatment decisions: 42% of those with pneumonia, 41% of those with gangrene and 70% of those with cancer.

The authors write: “Although many patients wished to involve their families in decision making, very few would allow their family the final decision. This finding suggests that patients want their families to support their decision making, rather than to provide a third opinion independent of both themselves and the physician.”

In conclusion: “The present study found that, compared with the United States, Canada, Israel and Russia, there was no clear evidence that Japanese patients prefer more passive roles than do their counterparts in Western countries.”