Differences in code status practice patterns among emergency clinicians working in Japan and the United States

Area of Science:

• Medical Ethics
• Cross-cultural Healthcare Communication
• Emergency Medicine

Background:

• Code status discussions are crucial for end-of-life care in critical illness.
• Understanding international variations in communication practices is essential for global healthcare standards.
• Emergency clinicians play a vital role in initiating serious illness conversations.

Purpose of the Study:

• To compare self-reported code status communication practices between emergency clinicians in Japan and the U.S.
• To investigate differences in posing procedure-based versus value-based questions to critically ill patients.

Main Methods:

• A cross-sectional questionnaire study involving 176 emergency clinicians from Japan and the U.S.
• Participants responded to a hypothetical case of a critically ill patient with end-stage lung cancer.
• Questionnaire assessed likelihood of asking about patient preferences, values, and goals.

Main Results:

• Japanese emergency clinicians were less likely to ask procedure-based questions compared to U.S. counterparts.
• Japanese emergency clinicians were more likely to ask value-based questions (10 out of 12 assessed).
• Significant cross-cultural differences in self-reported communication practices were observed.

Conclusions:

• Substantial disparities exist in how emergency clinicians in Japan and the U.S. approach serious illness conversations.
• Current U.S.-based serious illness communication training requires adaptation for the Japanese cultural context.
• Consideration of cultural nuances and professional roles is vital for effective cross-cultural healthcare communication training.