Do Adult Kids Know Enough About Their Parents' Wishes for End-of-Life?

Monday, 22 July 2013

Keiko Hattori, RN, PhD
Department of Nursing Faculty of Haelth and Welfale, Kawasaki University of Medical Welfare, Kurashiki, Japan
Misae Ito, RN, RMW, MSN, PhD
Department of Nursing, Faculty of Haelth and Welfale, Kawasaki University of Medical Welfare, Kurashiki, Japan

Learning Objective 1: The learner will be able to understand culturally different decision-making behaviors toward end-of-life.

Learning Objective 2: The learner will be able to explore the culturally considerate nursing interventions when their patients and their family need to make decisions about end-of-life care.

Purpose: Advance directives have not been legalized in Japan although over 80% of the population were in favor of this idea.  The Japanese elders believe that childrens' making decision for their parents is emotional burden and they want to avoid it.  The culturally shared mind for decision-making at the end-of-life among Japanese elders is "Children know our wishes."  However, family, especially children, might not play the culturally expected role anymore.  The recent economical crisis and declining the birth rates have led to dramatic changes in family structures and roles.  The purpose of this study was to clarify the gap in wishes for end-of-life between Japanese elders and their family members.

Methods: The total 1,000 paper-based questionnaires were distributed to elders and their family members in three prefectures in Japan.  Such three prectures were randomly selected based on its population size and aging rate.  The questionnaire asked for their backgrond, family functions, and wishes for thier end-of-life. Chi-square was used to analysis the data.

Results: The response rate has been around 80% (it's ongoing project). The participants living in larger cities have higher response rate, so that they have more interested in issues in advance directives.  One prefecture with smaill population size refused to participate in this research because they had felt barriers to ask end-of-lfe questions to elders.  So far, regionally influence was one of the factors of determining the gap.  The detailed analysis should be reported after all the questionnaires are returned.

Conclusion: The societal changes has been influencing the cultural decision-making process.  Nurses should assess the characteristics of individual's decision-making responses.