Conversations about death shouldn’t be so intimidating, which is why efforts are being made by Flinders University Caring Futures Institute researchers to promote advanced care planning and culturally sensitive end-of-life decision-making.
Many people avoid conversations about death and dying, particularly across different cultural contexts, where expectations, family roles and beliefs about specific types of care can differ significantly.
To help understand this issue and change public acceptance of challenging care conversations, Dr Yumi Naito from Flinders’ Research Centre for Palliative Care, Death, and Dying (RePaDD) is exploring how people can have better conversations about care preferences, autonomy and quality of life before a crisis occurs.
Dr Naito, a registered nurse qualified in both Japan and Australia, is conducting research that focuses on individual and personal decision-making about end-of-life issues, advance care planning (ACP), patient-centred care and dementia.
“Preparing for death is also about preparing for how we want to live,” says Dr Naito. “To address this, culturally safe care matters at every step of the care process, and better communication can reduce distress for patients and families at end of life.”
Dr Naito has been actively engaged in international initiatives to improve ACP practices between Japan and Australia since 2019. Her scholarly work includes findings and analysis on the perspectives of nurses, physicians and older adults about end-of-life decision making, which she presented at Advance Care Planning International conferences through 2025.
To help promote her academic work, Dr Naito has delivered numerous public lectures in Japan to promote awareness and understanding of ACP, which has contributed to broader societal discourse on patient autonomy and quality of life in ageing populations.
“To raise public awareness of life and health care, we have to also prepare for death and dying, and the combination of all these things makes us think about a better life and purpose.”
Her unique position – residing in Australia while maintaining strong professional and academic ties in Japan – has enabled Dr Naito to facilitate transnational collaborations and contribute to the development of a globally connected research network.
Dr Naito’s PhD thesis – Cultural Influences on End-of-Life Decision Making in Japan among Doctors, Nurses, and Older Adults: An Ethnographic Study – provides a solid foundation on which her ongoing research has continued to explore people’s ability to address end-of-life care and preference, through the prism of cultural sensitiveness and advance care planning.
Research in her PhD thesis highlighted the importance of respecting patient autonomy while balancing family involvement, ensuring effective communication between patients, families, and health professionals – and recognised emotional and ethical challenges in achieving culturally-sensitive decisions for end-of-life care.
“My research also reflected both shared and differing perspectives among doctors, nurses, and older adults, emphasising key discussion points such as the exclusion of the dying person from decision making, strong cultural and hierarchical influences, evolving attitudes and approaches, dealing with conflicts, understanding responsibilities, and the need to promote education.”
The implications of more open conversations about end-of-life decisions included a cultural shift influenced by transitioning from family-centred to patient-centred decision making. Legal reforms encouraged informed consent and transparency regarding end-of-life choices, shaped by global trends, public opinion, health literacy, ethics, and effective communication through specialised training in end-of-life care.
“This provides the important connection to improving quality of life, dignity, communication and support around death and dying,” says Dr Naito.
Dr Naito explains the implications of her research in a video presented by Flinders’ Research Centre for Palliative Care, Death, and Dying (RePaDD):
“It is a challenge to address both cultural and ethical challenges in expanding conversations about end-of-life decisions, but change can be encouraged through greater education and public awareness,” says Dr Naito.
“There are key points that we must continue to discuss, starting with the continuing practice of not including a dying person in decision making. Other areas of concern are the powerful influence of strong culutral influences and heirachial situations that can dominate decision-making, ahead of a dying person’s preferences.
“Improved public discussion about this can change these attitudes and create a new approach to preparing for death and dying.”