Comparison of end-of-life preferences between Japanese elders in the United States and Japan.

Significant attention is being paid to end-of-life preferences and their cultural variations. This study compares end-of-life preferences between older Japanese residing in Japan and the United States. A self-administered questionnaire was provided to elders affiliated with senior centers and clubs. Japanese Americans preferred to make decisions themselves about withholding life-sustaining treatments, whereas Japanese in Japan preferred to rely on physicians and family members. The U.S. sample showed more positive attitudes toward and higher completion rates of advance directives than the Japanese sample. Results suggest that end-of-life preferences differ between Japanese elders in the two countries and that preferences are influenced by contextual factors in one's country of residence. Practitioners need to be aware of both within-group and across-group diversity in end-of-life preferences, taking into account acculturation changes.

Family response to end-of-life education: differences by ethnicity and stage of caregiving.

The authors developed and tested 5 educational booklets to improve end-of-life knowledge, attitudes, intention, and practices in a multiethnic sample of family caregivers of well, homebound, and institutionalized elders. Of 570 participants, 424 (74%) read at least 1 booklet and completed pretests and posttests. At 3-month follow-up, small improvements were seen in completion of advance directives, and significant increases were seen in proportions of caregivers with funeral or burial plans and willingness to consider hospice. The booklets had wide appeal, but end-of-life measures varied by care-giver stage and ethnicity, suggesting that these factors need to be considered in developing education interventions for family caregivers.