Paper: Information Disclosure Practices and Attitudes towards Health Decision-Making in Japanese Nurses and Physicians (40th Biennial Convention (October 31st- November 4th, 2009))

Sunday, November 1, 2009

Misae Ito, MSN, RN, NMW¹
Sue Turale, EdD, MSt, RN, RPN, FRCNA, FACMHN²
Takahiro Kakeda, RN, PHN³
Kyoko Murakami, PhD, RN, NMW²
Miki Saito, RN, PHN, MSN⁴
Simpei Hayashi, RN, PHN, MSN⁴
Keiko Hattori, RN, MCPN, PhD⁴
Noritoshi Tanida, MD, PhD⁵
1Department of Nursing, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
2Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
3Department of Nursing, Faculty of Health and Welfare, Kawasaki University of Medical Welfare, Kurashiki-city, Okayama, Japan
4Faculty of Health and Welfare, Kawasaki University of Medical Welfare, Okayama, Japan
5Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan

Learning Objective 1: Understand distressing ethical concerns of Japanese nurses and physicians regarding patient information disclosure.

Learning Objective 2: Appreciate cultural implications of patient autonomy and family participation in decision-making.

In Japan, like in other parts of Asia, there has been an especial history of medical care being paternalistic, for example, health providers withholding life-threatening illness information from patients. Recently many Japanese patients want disclosure of their diagnosis and prognosis, for example when cancer may cause death in young patients, and doctors often include families in decision-making about a patient’s health. Such practices have the potential to cause ethical dilemmas and problems for nurses who feel obliged to assist with the withholding of information.

This study clarified the perceptions of 279 Japanese clinical nurses and 73 physicians regarding their experiences with family requests regarding health care decision making and desired involvement of patient in decision making. Following research approval, a structured self-descriptive questionnaire was administered in two teaching hospitals. Data was analysed using descriptive statistics.

Twenty to 30 % of nurses and physicians experienced at least one family request to withhold information about a patient’s diagnosis and prognosis. The majority of respondents experiencing such requests abided by them to some degree. The extent to which the nurses and physicians talked about a patient’s prognosis to the patient and family were varied. Approximately 70% of physicians and nurses thought that families could make decisions about important medical treatments for competent patients in some circumstances. One third of nurses and physicians expressed no family decision making for competent patient. The preferences regarding the decision making process for competent patients were more centered on the fact that a patient makes a final decision after consulting with physician and family. Data showed that there were distressing ethical concerns among physicians and nurses regarding information disclosure when talking to patients and the families in a variety of situations.

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