Monday, May 21, 2012

Breaking Bad News to Asian Patients

Cultural Differences

Only 30% of Asian patients want to discuss life expectancy, whereas 60% of Western patients do.  Of Japanese patients, 78% want a family member present when learning news about a bad prognosis, starkly contrasting with US patients, 81% of whom prefer to be alone.

These are examples of the widely varying cultural preferences highlighted in “Breaking Bad News to Asian Patients,” an article subtitled “A Primer on Asian Bioethics,” by Desiree Lie at Medscape (  She cites several studies about communicating bad news to patients, noting the contrast in preferences of Asian patients.

The author notes that although both Asian and Western bioethics stress truth-telling and autonomy, the Asian conception of autonomy considers the family as the autonomous unit whereas the Western application of the ethical principle in medicine generally refers to the individual.  Lie states that in Asian culture, the first person to be told about a diagnosis of cancer is the head of the household—not the patient.  Lie acknowledges that traditions vary within cultures and within the same cultural group in different geographic regions.

Lie suggests 1) asking the patient what he or she prefers when having a diagnosis presented, 2) finding out who is the center of decision-making in the family, and 3) inviting the patient to share “ancestral values” about illness, the role of family members and spiritual beliefs.  These kinds of conversations may furnish you with clues to the best routes of communication.

Author Lie says, “Allowing [the patient] to make the initial decision of how to be given news about her diagnosis gives her and her family ‘face’ and is likely to improve follow-up, communication, satisfaction, adherence, and future management of her disease.”

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

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