Patients' Desire to Participate in Decision-Making in Psychiatry: A Questionnaire Survey in Japan

Abstract

Japanese national sentiment has been described as paternalistic, which has potentially wide-ranging implications for the manner in which psychiatric patients should participate in medical decision-making. To examine the extent and possible determinants of the desire to participate in medical decision-making among Japanese people, we distributed a packet of questionnaires to 747 (nonmedical) university students and 114 of their parents. The questionnaires included an imaginary case vignette of psychotic depression. The participants were asked whether they would want various types of medical information, i.e., diagnosis, aetiology, treatment, outcomes, medical charts, etc., disclosed to them were they in such a psychiatric condition. Also included was the 1995 Scale for Independent and Interdependent Construal of the Self by Kiuchi. More than half of the participants wanted all the types of medical information disclosed to them. Those participants who wanted to have all types of information disclosed to them (n = 413) as compared to those who did not want to know at least one type of information (n = 445), tended to be male and to have an educational background in psychiatry (9.7% vs 5.4%) as well as an assertive attitude as indicated by a higher score on Independence on the Scale for Independence and Interdependent Construal of the Self. These results suggest that the Japanese in this sample are more likely to want to make an autonomous contribution to the psychiatric decision-making process and that less desire for information can be predicted by some demographic and personality factors.

Stress‐reductive effects of information disclosure to medical and psychiatric patients

“…Despite a lack of convincing empiric data to support the beneficial effects of information disclosure in medicine, the present literature review shows that an avenue to a better future means to disclose information to individual patients. I would like to emphasize that this is in line with the patients’ desire to know medical information related to themselves 51 . The present literature review would encourage clinicians to disclose information to patients not only from the legal aspects (patients have right to know) but also from clinical perspective (they may benefit from it).…”

Physician strategies for addressing patient adherence to prescribed psychotropic medications in Japan: a qualitative study

“…The traditional mode of treatment decision‐making in Japan – the omakase (entrusting) model – is unilateral and does not promote patient education (e.g., physicians and patients seldom share disease and treatment‐related information) (11). Ultimately, this type of decision‐making limits physicians capacity to address patient ‘misperceptions’ of and resistance to psychiatric treatment (12), despite the fact that Japanese patient misperceptions of anti‐depressant medications are strongly tied to intentional non‐adherence (13).…”

Annual Intensive One-week Course in Medical Ethics

“…A recent study in Japan also found education to be a determining factor. 6 About a quarter of the physicians state that they inform their patients between 50% and 90% of the time. Over half of the physicians inform their patients in general terms of their illnesses but not in detail.…”