Their guidelines have been drawn up based on those in Western countries, and they aim at an ideal form of communication between the medical staff, patients and their families. In Japan, truth-telling, or revealing the diagnosis, is not the usual custom. Up to a certain point, this hope supports the desire of the patient who would like to live longer. However, as the disease progresses, suspicion begins to creep in. Suspicion is almost always followed by anxiety.
Irritability is followed by depression.
However, those who do not ask questions become depressed without going through a stage of irritability. A very small number of patients die after a stage of denial, or after trying to fight. It is important for liaison psychiatrists across the globe to report on their clinical experiences. These findings can help to create a more appropriate model of the doctor-patient relationship as well as provide important information about the psychology of transplant and cancer patients and their families. There is still considerable room for psychiatrists to have wider-ranging influences on the practice of oncology in Japan.