Study examines death across cultures

Karl Lorenz, MD, MSHS, a palliative care researcher with the Veterans Affairs Greater Los Angeles Healthcare System, has found that death brings the importance of culture in medical care into sharper focus.

"From the time of my earliest experience in medicine, how families negotiate dying has been something that has perplexed and bothered me," said Dr. Lorenz, an assistant professor at the David Geffen School of Medicine at UCLA.

He recalled an experience with an Asian-American family. A language barrier made communicating difficult. "We were struggling to find words to talk about death." It was awkward, and later, in discussing it with a colleague, Dr. Lorenz learned that averting his eyes may have been appropriate. "It was an intuitive nonverbal repertoire that I didn't have access to," he said.

His passion for palliative care helped spark a recent study comparing how medical residents in Japan and the United States deal with patients and families making end-of-life decisions. The study, which was published in the July issue of Academic Medicine, was led by Baback Gabbay, MD, a fourth-year medical student at David Geffen School of Medicine at UCLA, and contributed to by several other physicians in the United States and Japan, including Dr. Lorenz.

The study found that many residents in both countries lied to patients about terminal prognoses and feel conflicted about their actions.

Given the increasing cultural and racial diversity among the aging, addressing cross-cultural issues related to information disclosure would be particularly helpful for U.S. medical residents, according to the study.

In the study, Japanese medical residents were more likely than U.S. residents to include the family when disclosing diagnosis and prognosis of advanced gastric cancer. Japanese residents also were more likely to discuss the patient's condition with the patient's family first.

Of the respondents who had cared for at least one dying patient, 78% of Japanese and 18% of U.S. medical residents lied to their patients at the family's request. Of those, 45% of Japanese and 61% of U.S. trainees reported feeling guilty as a result.

Researchers speculated that the Japanese preference for speaking to the family first was part of a culture that tends to make decisions as a group. Japanese families also put a high importance on protecting family members from the psychological stress of being diagnosed with cancer.