Journal of General Internal Medicine

, Volume 17, Issue 7, pp 531–539 | Cite as

Acculturation of attitudes toward end-of-life care

A cross-cultural survey of Japanese Americans and Japanese
  • Shinji Matsumura
  • Seiji Bito
  • Honghu Liu
  • Katharine Kahn
  • Shunichi Fukuhara
  • Marjorie Kagawa-Singer
  • Neil Wenger
Original Articles


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.

Key words

cross-cultural comparison acculturation terminal care advance directives decision making 


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Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Shinji Matsumura
    • 1
    • 4
  • Seiji Bito
    • 3
  • Honghu Liu
    • 1
  • Katharine Kahn
    • 1
  • Shunichi Fukuhara
    • 4
  • Marjorie Kagawa-Singer
    • 2
  • Neil Wenger
    • 1
  1. 1.the Division of General Internal Medicine and Health Services ResearchUniversity of California-Los AngelesLos Angeles
  2. 2.the School of Public Health and Asian American StudiesUniversity of California-Los AngelesLos Angeles
  3. 3.National Tokyo Medical CenterUniversity of TokyoTokyoJapan
  4. 4.the Graduate School of MedicineUniversity of TokyoTokyoJapan

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