25 Cultural influences on end of life decision making for older adults in Japan

<h3>Background/Aims</h3> Japan has experienced rapid ageing as the world’s oldest population. The number of older people aged over 65 accounts for 30% 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 advance care planning. The aim was to explore and understand health professionals’ cultural perspectives on death and dying and end of life decision making for older Adults in Japan. <h3>Methods</h3> This study utilised a qualitative design underpinned by ethnography. Following ethical approval, 20 nurses and 20 physicians were recruited from a large healthcare service in Japan. Additionally, 20 older adults were interviewed using a semi-structured format, and the audiotapes were transcribed for thematic analysis. <h3>Results</h3> Nurses wanted the patient to have a peaceful and good death. Physicians practised culturally appropriate patient centred care and trying to achieve good results. There were a number of themes common to both nurses and physicians including emotional conflict and ethical dilemma, patient centred care and communication challenges. There were also some differences between the two groups that patient centred care around decision makings and quality of life care. Overall, the perspectives of death and dying and decision making were grounded in Japanese culture. <h3>Discussion</h3> Cultural factors substantially influenced the decision making in end of life care in Japan. The results identified the need to investigate health professionals’ role in providing individually focused and quality care that also adopted Japanese cultural aspects for adults. Understanding the healthcare professionals’ perspectives about end of life care decision making were the key to implementing patient centred care for older adults in this country. Unique contributions in this study include the real hidden voice of older adults perspectives of end of life decisions, they want to have a choice of dying. Implications for utilising an adaptation of advance care planning to Japanese culture by consciously enhancing and supporting individual’s autonomous decision making may facilitate its establishment in Japan and other societies with family centred decision making culture. It is important to note public awareness and education.