Dr Yumi Naito1, Doctor Anita De Bellis1, Doctor Craig Phillips1, Doctor Oluwatomilayo Omoya1
1Flinders University, Adelaide, Australia
Biography:
Yumi Naito, MN, RN, is a PhD candidate at Flinders University, a registered nurse qualified in both Japan and Australia. Her research focuses on end-of-life decision-making, advanced care planning (ACP), patient-centred care, and dementia. As an early-career researcher, she employs qualitative and mixed-method approaches, with a strong focus on cultural influences and cross-cultural perspectives in healthcare.
She is dedicated to public engagement and health education, giving lectures across Japan on ACP to raise awareness about patient autonomy and quality of life. Living in Australia but connected to Japan, she fosters transnational collaborations and helps build a global research network.
Abstract:
End-of-life decision making is a critical aspect of patient-centered care, yet in Japan, many individuals struggle to express or assert their preferences regarding treatment and care during the final stages of life. This qualitative ethnographic study explored Japanese nurses’ perspectives on the cultural factors that influence patients’ autonomy in end-of-life care. Drawing on semi-structured interviews with eighteen registered nurses across various healthcare settings, the findings reveal that deeply rooted cultural values—such as filial piety, collectivism, and deference to medical authority—often inhibit patients from making independent decisions. Nurses reported that family expectations, societal norms around death, and hierarchical relationships within healthcare teams contribute to a reluctance among patients to voice their wishes. The study highlights the tension between traditional cultural beliefs and the growing emphasis on advance care planning and patient autonomy. Understanding these cultural dynamics is essential for developing culturally sensitive approaches to end-of-life care in Japan and for supporting healthcare professionals in facilitating meaningful conversations with patients and families.
The findings revealed cultural influences on decision making, how cultural values such as harmony, the priority of the decision and ethical dilemma connected patient autonomy. Four major themes emerged: cultural factors in decision-making, nurses’ desire for a peaceful and dignified death, emotional conflicts, and communication challenges. Direct quotes from nurses illustrated the tension between traditional norms and the increasing focus on patient-centred care. The study underscored the need for culturally sensitive approaches in advance care planning in Japan. It also highlights the importance of education, policy, research, and practical implications.