Takashi Yamaguchi1, Isseki Maeda2, Yutaka Hatano3, Sang-Yeon Suh4, Shao-Yi Cheng5, Sun Hyun Kim6, Ping-Jen Chen7, Tatsuya Morita8, Satoru Tsuneto9, Masanori Mori8. 1. Division of Palliative Care Konan Medical Center, Kobe, Japan. Electronic address: ikagoro@pop06.odn.ne.jp. 2. Department of Palliative Care, Senri Chuo Hospital, Suita, Japan. 3. Hospice, Gratia Hospital, Minoo, Japan. 4. Department of Family Medicine, Palliative Care Center, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Medicine, School of Medicine, Dongguk University, Seoul, Korea. 5. Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan. 6. Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea. 7. Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK. 8. Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 9. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: The characteristics of physician communication with patients at the end of life (EOL) in East Asia have not been well studied. We investigated physicians' communications with imminently dying patients with cancer and their families in palliative care units (PCUs) in Japan, South Korea, and Taiwan. METHODS: This observational study included patients with cancer newly admitted and deceased during their first admission to 39 PCUs in three countries. We evaluated 1) the prevalence and timing of informing patients and families of patients' impending death and 2) the prevalence of communication to assure the families of the patient's comfort. RESULTS: We analyzed 2138 patients (Japan: 1633, South Korea: 256, Taiwan: 249). Fewer Japanese (4.8%: 95% confidence interval [95% CI], 3.8%-5.9%) and South Korean (19.6%: 95% CI, 15.2%-25.0%) patients were informed of their impending death, whereas 66.4% (95% CI, 60.2%-72.1%) of Taiwanese were informed; among all three countries, ≥90% of families were informed. Although most patients in all three countries and the families in South Korea and Taiwan were informed of the impending death greater than or equal to four days before death, 62.1% (95% CI, 59.6%-64.6%) of Japanese families were informed less than or equal to three days prior. Most families in all three countries received assurance that the patient would remain comfortable (could hear until death, no distress with death rattle or respiration with mandibular movement). CONCLUSIONS: Physicians in Taiwan communicated about patient's impending death most frequently, and physicians in all three countries generally provided assurance to families that the patients would remain comfortable. Further studies should explore the reasons for these differences and the effects of such communications in East Asia.
BACKGROUND: The characteristics of physician communication with patients at the end of life (EOL) in East Asia have not been well studied. We investigated physicians' communications with imminently dying patients with cancer and their families in palliative care units (PCUs) in Japan, South Korea, and Taiwan. METHODS: This observational study included patients with cancer newly admitted and deceased during their first admission to 39 PCUs in three countries. We evaluated 1) the prevalence and timing of informing patients and families of patients' impending death and 2) the prevalence of communication to assure the families of the patient's comfort. RESULTS: We analyzed 2138 patients (Japan: 1633, South Korea: 256, Taiwan: 249). Fewer Japanese (4.8%: 95% confidence interval [95% CI], 3.8%-5.9%) and South Korean (19.6%: 95% CI, 15.2%-25.0%) patients were informed of their impending death, whereas 66.4% (95% CI, 60.2%-72.1%) of Taiwanese were informed; among all three countries, ≥90% of families were informed. Although most patients in all three countries and the families in South Korea and Taiwan were informed of the impending death greater than or equal to four days before death, 62.1% (95% CI, 59.6%-64.6%) of Japanese families were informed less than or equal to three days prior. Most families in all three countries received assurance that the patient would remain comfortable (could hear until death, no distress with death rattle or respiration with mandibular movement). CONCLUSIONS: Physicians in Taiwan communicated about patient's impending death most frequently, and physicians in all three countries generally provided assurance to families that the patients would remain comfortable. Further studies should explore the reasons for these differences and the effects of such communications in East Asia.