Abstract
BackgroundOver the last decade, patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Japanese people regarding involvement in treatment-related decision-making are limited. The main objectives of this study were to (1) reveal the actual level of involvement of Japanese cancer patients in the treatment-related decision-making and their overall satisfaction with the decision-making process, and (2) consider the practical implications of increased satisfaction in cancer patients with regard to the decision-making process.MethodsWe conducted semi-structured interviews with 24 Japanese cancer patients who were recruited from a cancer self-help group in Tokyo. The interviews were qualitatively analysed using the approach described by Lofland and Lofland.ResultsThe analyses of the patients' interviews focused on 2 aspects: (1) who made treatment-related decisions (the physician or the patient), and (2) the informants' overall satisfaction with the decision-making process. The analyses revealed the following 5 categories of decision-making: 'patient as the active decision maker', 'doctor selection', 'wilfully entrusting the physician', 'compelled decision-making', and 'surrendering decision-making'. While the informants under the first 3 categories were fairly satisfied with the decision-making process, those under the latter 2 were extremely dissatisfied. Informants' views regarding their preferred role in the decision-making process varied substantially from complete physician control to complete patient control; the key factor for their satisfaction was the relation between their preferred involvement in decision-making and their actual level of involvement, irrespective of who the decision maker was.ConclusionIn order to increase patient satisfaction with regard to the treatment-related decision-making process, healthcare professionals in Japan must assess individual patient preferences and provide healthcare accordingly. Moreover, a better environment should be created in hospitals and in society to facilitate patients in expressing their preferences and appropriate resources need to be made available to facilitate their decision-making process.
Highlights
Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism
This study aimed to explore the actual level of involvement of Japanese cancer patients in treatment-related decision-making as well as their overall satisfaction with the decision-making process
This study revealed that Japanese cancer patients' preferences regarding their role in treatment-related decisionmaking varied widely from complete physician control to complete patient control, which is similar to the preceding studies conducted in the US, the UK, and Canada [912,14,15]
Summary
Patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Charles and colleagues provided useful suggestions for developing a framework for the analysis of treatmentrelated decision-making and proposed 3 analytical approaches that have been reported in the recent history of developed countries: the paternalistic approach, characterised by physician control; the informed approach, characterised by division of labour and preservation of patient autonomy; and the shared approach, characterised by simultaneous interaction between both the patient and physician in all stages of the decision-making process [7]. They suggested that decision-making is not merely the act of 'making a decision'; it is an interactive process between a patient and her/his physician. They argue that the third step is an outcome of the deliberation process
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